Many Seniors With Heart Failure Take 10-plus Meds
By Cara Roberts Murez
TUESDAY, October 13, 2020 (HealthDay News) – When older people hospitalized with heart failure are discharged home, they are often given 10 medications to take for a variety of conditions. But is this practice of “polypharmacy” necessary or does it only weigh heavily on already fragile patients?
It’s not so much a question of the quantity of drugs, but whether the drugs patients are taking are the right ones for them, said lead author of the study, Dr. Parag Goyal, a geriatric cardiologist at New York. Presbyterian in New York.
“It’s not just that we don’t start the right drugs, there may be situations where we don’t stop the wrong drugs as well,” Goyal said. “I think we need to look at the medications that older people with heart failure take in a more holistic way.”
For the study, Goyal’s team looked at the medical records of 558 adults aged 65 and older hospitalized in the United States between 2003 and 2014.
At admission, 84% of patients were taking five or more medications and 42% were taking 10 or more. On discharge, this number had increased to 95% of patients who prescribed five or more drugs and 55% who took 10 or more. Most of the medications prescribed were not intended for patients’ heart failure or heart problems, the researchers said.
A greater drug load increases the risk of adverse drug reactions, which could lead to patients ending up in hospital, Goyal explained. It may also require more work for the patient, which can impact the quality of life.
“It’s a big challenge,” Goyal said. “How exactly do you reconcile the fact that a lot of these drugs are meant to prevent events and help patients feel better with the concept that as the number of drugs increases you could be negatively affecting these settings? “
The study found that about 90% of older people with heart failure have at least three other health problems. Over 60% have at least five other conditions.
The results were published online on October 13 in the journal Circulation: heart failure.
The researchers concluded that there was a need to develop strategies to mitigate the negative effects of polypharmacy. Among the drugs that can be overused are proton pump inhibitors, which reduce stomach acid. There are a host of drugs that patients have been taking for years that could be considered, Goyal noted.
However, the study suggests that the benefits of the drugs may outweigh the risks of polypharmacy for people with certain conditions, including chronic obstructive pulmonary disease (COPD) and diabetes.
Some drugs are already versatile, including one that treats diabetes and heart failure, said Dr. Gregg Fonarow, chief of the cardiology division at the University of California, Los Angeles.
“This does not mean that there are not certain drugs that are not needed and could be reduced or consolidated, but that for patients with heart failure who have a number of other co-morbid conditions, a certain many drugs have been proven in randomized trials., proven in clinical efficacy studies – including in patients over 65 – where the more patients are on treatment, the better the clinical results ” Fonarow added.
Common conditions in patients with heart failure include diabetes, COPD and atrial fibrillation (an irregular heartbeat), said Fonarow, who was not involved in the new study.
“These patients suffer from many other comorbid conditions which, if left untreated, put them at risk of complications,” he added.
The American Heart Association defines heart failure as “a chronic, progressive disease in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.”
About 6 million Americans suffer from heart failure. It’s one of the most common reasons people aged 65 and over are hospitalized, Fonarow said, and it has a high death rate.
Goyal noted that a patient’s doctors – from primary care physicians to specialists – should take the time to review the patient’s medications to determine if they are still needed.
Goyal said he would develop a shared decision-making approach to optimize medication for older people with heart failure, a five-year project recently funded by the US National Institutes of Health.
“I think it’s important to reconsider and regularly review medications to make sure that a medication that has been previously prescribed is still the right medication,” Goyal said.
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