Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Nov;13(11):e006977.
doi: 10.1161/CIRCHEARTFAILURE.120.006977. Epub 2020 Oct 13.

Polypharmacy in Older Adults Hospitalized for Heart Failure

Ozan Unlu  1 , Emily B Levitan  2 , Evgeniya Reshetnyak  3 , Jerard Kneifati-Hayek  4 , Ivan Diaz  5 , Alexi Archambault  3 , Ligong Chen  2 , Joseph T Hanlon  6 , Mathew S Maurer  7 , Monika M Safford  3 , Mark S Lachs  8 , Parag Goyal  3   9
Affiliations
Observational Study

Polypharmacy in Older Adults Hospitalized for Heart Failure

Ozan Unlu et al. Circ Heart Fail. 2020 Nov.

Abstract

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke).

Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare's Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related.

Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications.

Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

Keywords: heart failure; hospitalization; polypharmacy; prevalence.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Distribution of medication count
Polypharmacy, defined as the condition of taking at least 10 medications, occurred in 42% of adults with heart failure at hospital admission (A) and 55% at hospital discharge (B) A. At Hospital Admission B. At Hospital Discharge
Figure 1.
Figure 1.. Distribution of medication count
Polypharmacy, defined as the condition of taking at least 10 medications, occurred in 42% of adults with heart failure at hospital admission (A) and 55% at hospital discharge (B) A. At Hospital Admission B. At Hospital Discharge
Figure 2.
Figure 2.. Temporal Trends of Polypharmacy
Polypharmacy, defined as the condition of taking at least 10 medications, at both admission and discharge increased in prevalence between the 2003–2006 period and 2011–2014 period.
Figure 3.
Figure 3.. Median Number of Medications by Medication Classes Over Time
The median number of medications increased over time. This increase was most notable among non-cardiovascular (non-CV) medications. Abbreviations: CV, cardiovascular; HF, heart failure; Non-CV, Non-cardiovascular A. At Hospital Admission B. At Hospital Discharge
Figure 3.
Figure 3.. Median Number of Medications by Medication Classes Over Time
The median number of medications increased over time. This increase was most notable among non-cardiovascular (non-CV) medications. Abbreviations: CV, cardiovascular; HF, heart failure; Non-CV, Non-cardiovascular A. At Hospital Admission B. At Hospital Discharge
Figure 4.
Figure 4.. Medication Class Counts According to Total Medication Count
As the number of total medications increased, the number of non-cardiovascular (non-CV) medications increased more rapidly compared to either heart failure (HF) medications or non-HF cardiovascular (CV) medications at both admission (A) and discharge (B). Abbreviations: CV, cardiovascular; HF, heart failure; Non-CV, Non-cardiovascular A. At Hospital Admission B. At Hospital Discharge
Figure 4.
Figure 4.. Medication Class Counts According to Total Medication Count
As the number of total medications increased, the number of non-cardiovascular (non-CV) medications increased more rapidly compared to either heart failure (HF) medications or non-HF cardiovascular (CV) medications at both admission (A) and discharge (B). Abbreviations: CV, cardiovascular; HF, heart failure; Non-CV, Non-cardiovascular A. At Hospital Admission B. At Hospital Discharge
See this image and copyright information in PMC

Comment in

References

    1. McMurray JJV, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS, Belohlavek J, Bohm M, Chiang CE, Chopra VK, de Boer RA, Desai AS, Diez M, Drozdz J, Dukat A, Ge J, Howlett JG, Katova T, Kitakaze M, Ljungman CEA, Merkely B, Nicolau JC, O’Meara E, Petrie MC, Vinh PN, Schou M, Tereshchenko S, Verma S, Held C, DeMets DL, Docherty KF, Jhund PS, Bengtsson O, Sjostrand M, Langkilde AM, Committees D-HT and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381:1995–2008. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ and Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:1810–52. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW and Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017. - PubMed
    1. Centers for Medicare & Medicaid Services. Chronic Conditions among Medicare Beneficiaries. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren... Accessed February 18, 2019.
    1. Maher RL, Hanlon J and Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65. - PMC - PubMed

Publication types

MeSH terms

Substances