Open Access
Issue
Published:
30 June 2023
Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up
)
Download citation
829
Views
137
Downloads
0
Crossref
0
WoS
0
Scopus
0
CSCD
To investigate the prevalence of polypharmacy and potentially inappropriate medication (PIM) in elderly patients with heart failure (HF) and their impact on readmission and mortality.
We conducted a study of 274 participants aged 60 years or older with HF. The prevalence of polypharmacy (defined as the use of five or more medications) was calculated, and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs. Medications and PIMs were characterized at admission and discharge, and changes in prescriptions during hospitalization were compared. The impact of polypharmacy and PIM on readmission and mortality were investigated.
The median age of this study population was 68 years old. The median number of prescribed drugs was 7 at admission and 10 at discharge. At discharge, 99.27% of all patients were taking five or more drugs. The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months. The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission, while the use of non-cardiovascular medications increased the composite endpoint events. The frequency of PIMs was 93.79% at discharge. The incidence of composite endpoint events increased with the number of PIMs. “PIMs in older adults with caution” increased cardiovascular readmission and “PIMs based on kidney function” increased cardiovascular mortality. Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission.
Polypharmacy and PIM were highly prevalent in elderly patients with HF, and their use was associated with an increased risk of composite endpoint events, readmission and mortality. Non-cardiovascular medications, “PIMs in older adults with caution”, “PIMs based on kidney function” and several comorbidities were important factors associated with hospital readmission and mortality. Our findings highlight the importance of medication optimization in the management of HF in elderly patients.
menu
Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up
)
Abstract
To investigate the prevalence of polypharmacy and potentially inappropriate medication (PIM) in elderly patients with heart failure (HF) and their impact on readmission and mortality.
We conducted a study of 274 participants aged 60 years or older with HF. The prevalence of polypharmacy (defined as the use of five or more medications) was calculated, and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs. Medications and PIMs were characterized at admission and discharge, and changes in prescriptions during hospitalization were compared. The impact of polypharmacy and PIM on readmission and mortality were investigated.
The median age of this study population was 68 years old. The median number of prescribed drugs was 7 at admission and 10 at discharge. At discharge, 99.27% of all patients were taking five or more drugs. The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months. The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission, while the use of non-cardiovascular medications increased the composite endpoint events. The frequency of PIMs was 93.79% at discharge. The incidence of composite endpoint events increased with the number of PIMs. “PIMs in older adults with caution” increased cardiovascular readmission and “PIMs based on kidney function” increased cardiovascular mortality. Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission.
Polypharmacy and PIM were highly prevalent in elderly patients with HF, and their use was associated with an increased risk of composite endpoint events, readmission and mortality. Non-cardiovascular medications, “PIMs in older adults with caution”, “PIMs based on kidney function” and several comorbidities were important factors associated with hospital readmission and mortality. Our findings highlight the importance of medication optimization in the management of HF in elderly patients.
References(39)
Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118: 3272−3287.
Dharmarajan K, Rich MW. Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart Fail Clin 2017; 13: 417−426.
Costantino S, Paneni F, Cosentino F. Ageing, metabolism and cardiovascular disease. J Physiol 2016; 594: 2061−2073.
Diez-Villanueva P, Jimenez-Mendez C, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol 2021; 18: 219−232.
Díez-Villanueva P, Jiménez-Méndez C, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol 2021; 18: 219−232.
El Hadidi S, Rosano G, Tamargo J, et al. Potentially inappropriate prescriptions in heart failure with reduced ejection fraction: ESC position statement on heart failure with reduced ejection fraction-specific inappropriate prescribing. Eur Heart J Cardiovasc Pharmacother 2022; 8: 187−210.
Kanasi E, Ayilavarapu S, Jones J. The aging population: demographics and the biology of aging. Periodontol 2000 2016; 72: 13−18.
Fu X, Sun N, Xu F, et al. Influencing factors of inequity in health services utilization among the elderly in China. Int J Equity Health 2018; 17: 144.
Writing Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail 2022; 28: e1−e167.
Kim J, Parish AL. Polypharmacy and medication management in older adults. Nurs Clin North Am 2017; 52: 457−468.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009; 85: 86−8.
Mekonnen AB, Redley B, De Courten B, et al. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87: 4150−4172.
Sganga F, Vetrano DL, Volpato S, et al. Physical performance measures and polypharmacy among hospitalized older adults: results from the CRIME study. J Nutr Health Aging 2014; 18: 616−621.
Fabbietti P, Ruggiero C, Sganga F, et al. Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals. Arch Gerontol Geriatr 2018; 77: 158−162.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13: 57−65.
Unlu O, Levitan EB, Reshetnyak E, et al. Polypharmacy in older adults hospitalized for heart failure. Circ Heart Fail 2020; 13: e006977.
Pages A, Rouch L, Costa N, et al. Potentially inappropriate medication prescribing detected by computer algorithm among older patients: results from the MAPT study. Pharmacy (Basel) 2021; 9: 189.
By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019; 67: 674−694.
Muhlack DC, Hoppe LK, Weberpals J, et al. The association of potentially inappropriate medication at older age with cardiovascular events and overall mortality: a systematic review and meta-analysis of cohort studies. J Am Med Dir Assoc 2017; 18: 211−220.
Lu WH, Wen YW, Chen LK, et al. Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study. CMAJ 2015; 187: E130−E137.
Lin HY, Liao CC, Cheng SH, et al. Association of potentially inappropriate medication use with adverse outcomes in ambulatory elderly patients with chronic diseases: experience in a Taiwanese medical setting. Drugs Aging 2008; 25: 49−59.
Skoldunger A, Fastbom J, Wimo A, et al. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging 2015; 32: 671−678.
Harrison SL, Kouladjian O'donnell L, Milte R, et al. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr 2018; 18: 9.
Heider D, Matschinger H, Meid AD, et al. The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances. Results of a retrospective matched cohort study. PLoS One 2018; 13: e0198004.
Butler J, Anker SD, Packer M. Redefining heart failure with a reduced ejection fraction. JAMA 2019; 322: 1761−1762.
Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17: 230.
Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007; 63: 187−195.
Wastesson JW, Morin L, Tan ECK, et al. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018; 17: 1185−1196.
Basnet S, Zhang M, Lesser M, et al. Thirty-day hospital readmission rate amongst older adults correlates with an increased number of medications, but not with Beers medications. Geriatr Gerontol Int 2018; 18: 1513−1518.
Wu Y, Zhu W, He X, et al. Influence of polypharmacy on patients with heart failure with preserved ejection fraction: a retrospective analysis on adverse outcomes in the TOPCAT trial. Br J Gen Pract 2021; 71: e62−e70.
Pereira F, Verloo H, Zhivko T, et al. Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study. BMJ Open 2021; 11: e052755.
Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging de fi nition of 'deprescribing' with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015; 80: 1254−1268.
Payne RA, Avery AJ, Duerden M, et al. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol 2014; 70: 575−581.
Zhang X, Zhou S, Pan K, et al. Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging 2017; 12: 1697−1703.
Glans M, Kragh Ekstam A, Jakobsson U, et al. Medication-related hospital readmissions within 30 days of discharge-A retrospective study of risk factors in older adults. PLoS One 2021; 16: e0253024.
Fabbietti P, Di Stefano G, Moresi R, et al. Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study. Aging Clin Exp Res 2018; 30: 977−984.
Tao L, Qu X, Gao H, et al. Polypharmacy and potentially inappropriate medications among elderly patients in the geriatric department at a single-center in China: A retrospective cross-sectional study. Medicine (Baltimore) 2021; 100: e27494.
Jano E, Aparasu RR. Healthcare outcomes associated with beers' criteria: a systematic review. Ann Pharmacother 2007; 41: 438−447.
Gutierrez-Valencia M, Martinez-Velilla N, Vilches-Moraga A. Polypharmacy in older people: time to take action. Eur Geriatr Med 2019; 10: 1−3.
Publication history
Copyright
Acknowledgements
The authors express their gratitude to all the hospital staff who assisted with data retrieval from the electronic medical record database and routine telephone follow-up. Additionally, the authors would like to extend their appreciation to Wenhui Liu for providing statistical guidance at the School of Public Health, Shandong University. The authors declare that they have no conflicts of interests to disclose.
FEEDBACK 
TOP