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      Polypharmacy in Older Adults Hospitalized for Heart Failure

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          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.

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          Most cited references37

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          The Reasons for Geographic and Racial Differences in Stroke Study: Objectives and Design

          The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,000 African-American and white adults aged ≧45 years. The objective is to determine the causes for the excess stroke mortality in the Southeastern US and among African-Americans. Participants are randomly sampled with recruitment by mail then telephone, where data on stroke risk factors, sociodemographic, lifestyle, and psychosocial characteristics are collected. Written informed consent, physical and physiological measures, and fasting samples are collected during a subsequent in-home visit. Participants are followed via telephone at 6-month intervals for identification of stroke events. The novel aspects of the REGARDS study allow for the creation of a national cohort to address geographic and ethnic differences in stroke.
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            2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive Summary

            Circulation, 128(16), 1810-1852
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              Clinical consequences of polypharmacy in elderly.

              Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years. We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy. International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.
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                Author and article information

                Contributors
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                Journal
                Circulation: Heart Failure
                Circ: Heart Failure
                Ovid Technologies (Wolters Kluwer Health)
                1941-3289
                1941-3297
                October 13 2020
                Affiliations
                [1 ]Department of Medicine (O.U.), Weill Cornell Medicine, New York, NY.
                [2 ]Department of Epidemiology, University of Alabama at Birmingham (E.B.L., L.C.)
                [3 ]Division of General Internal Medicine/Department of Medicine (E.R., A.A., M.M.S., P.G.), Weill Cornell Medicine, New York, NY.
                [4 ]Division of General Internal Medicine (J.K.-H.), Columbia University Medical Center, New York, NY.
                [5 ]Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY.
                [6 ]Department of Medicine, University of Pittsburgh, PA (J.T.H.).
                [7 ]Division of Cardiology (M.S.M.), Columbia University Medical Center, New York, NY.
                [8 ]Division of Geriatrics/Department of Medicine (M.L.), Weill Cornell Medicine, New York, NY.
                [9 ]Division of Cardiology/Department of Medicine (P.G.), Weill Cornell Medicine, New York, NY.
                Article
                10.1161/CIRCHEARTFAILURE.120.006977
                33045844
                49d60314-d46e-4b56-82eb-afa1dda8c834
                © 2020
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