Study Finds Most Heart Failure Patients Taking 10 or More Medications at Discharge

Parag Goyal, MD, MSc

A recent study from physicians at Weill Cornell Medicine is raising the alarm on overprescribing medications to older patients hospitalized with heart failure.

Results of the study found more than half of older patients hospitalized for heart failure were discharged with prescriptions for 10 or more medications, which investigators warn can pose a threat to the safety of patients.

"High medication burden, also known as polypharmacy, is commonly associated with adverse events and reactions," said lead investigator Parag Goyal, MD, MSc, assistant professor of medicine at Weill Cornell Medicine and a geriatric cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center, in a statement from the American Heart Association. "As the treatment options for various conditions including heart failure expand and the population ages, it is becoming increasingly important to weigh the risks and possible benefits of multiple medications."

To expand the current knowledge base on real-world data related to polypharmacy in the setting of heart failure, Goyal and a team of colleagues from Weill Cornell Medicine and other institutions designed their analysis as an assessment of data within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which provided a nationwide cohort with data from more than 30,000 patients.

As part of their analysis, investigators determined the number of medications for each patient at hospital admission and discharge. Medications were classified by investigators by the primary condition they treat—these groups were defined as heart failure, other types of heart disease, or non-heart-related medications, which included medications with chronic kidney disease and type 2 diabetes.

In total, investigators identified 558 patients aged 65 years or older for inclusion in their analysis. The median age of this sample was 76 (IQR, 72-83) years, 44% were female, and 34% were black.

Upon analysis, investigators found 84% of patients were taking 5 or more medications at admission and 95% were taking that many at discharge. Further analysis indicated 42% of patients were taking 10 or more at admission and 55% were taking that many at discharge. Additionally, investigators pointed out the prevalence of patients taking 10 or more medications increased throughout the study period—pointing out the prevalence of patients taking 10 or more medications at discharge increased from 41% between 2003-2006 to 68% between 2011-2014.

"Our findings support the need to tailor decisions related to medication prescribing for each patient while considering their overall health status," Goyal added, in the aforementioned statement. "The key to managing polypharmacy is medication review during each appointment.”

Investigators pointed out their study was limited due to its design and data source. Of these, investigators noted by focusing on older adults with Medicare coverage their results are not generalizable to populations of younger adults or those not enrolled in Medicare.

This study, “Polypharmacy in Older Adults Hospitalized for Heart Failure,” was published in Circulation: Heart Failure.