Polypharmacy on first admission to hospital for people with heart failure: baseline findings from the PULSE cohort

Abstract

Aims: To define and characterize polypharmacy in people with heart failure.

Methods and results: The PULSE dataset is a bespoke single centre, retrospective, longitudinal, observational cohort database of patients hospitalized for heart failure, capturing data from the first heart failure admission through to death or end of data collection, including all subsequent admissions. First admission with heart failure was used to define baseline polypharmacy. There were 660 patients included in the dataset, 55.6% male, mean age 76.1 (±SD 12.3). Median number of medications on admission was 9 (25th-75th centile 7-12) and on discharge 10 (25th-75th centile 8-13). Polypharmacy prevalence was 87.3% on admission, increasing at discharge to 95.1% (P < 0.001). Mean medication complexity index score increased from 28.5 (±SD 14.9) at admission to 31.8 (±14.1) at discharge (P < 0.001). Number of medications on admission increased with increasing age (P < 0.001), higher Charlson Co-morbidity Index (P < 0.001), numerically more co-morbidities (P < 0.001), higher Clinical Frailty Scale (P < 0.001), longer length of stay (P = 0.03), worse New York Heart Association class of symptoms (P = 0.04), and a diagnosis of heart failure with preserved ejection fraction compared with heart failure with reduced ejection fraction (P = 0.002). Cardiovascular medications contributed 50% of medications. Prescribing of heart failure medications reduced with increased polypharmacy.

Conclusion: Polypharmacy is common on first admission to hospital for people with heart failure. More medications at admission are associated with increasing age, co-morbidity, and frailty. People with polypharmacy are more likely to have a heart failure with preserved ejection fraction diagnosis, have worse symptoms and a longer hospital stay.

Keywords: Heart failure; Medication complexity; Polypharmacy.