Abstract
AimsTo assess medication use in adult congenital heart disease (ACHD) patients compared to the age- and sex-matched general population, identify patterns of pharmacotherapy, and analyse associations between pharmacotherapy and adverse outcomes in ACHD.Methods and resultsData of 14 138 ACHD patients from the CONCOR registry [35 (24–48) years, 49% male] and age- and sex-matched referents (1:10 ratio) were extracted from the Dutch Dispensed Drug Register for the years 2006–14. Adult congenital heart disease patients had more cardiovascular and non-cardiovascular drugs than referents (median 3 vs. 1, P < 0.001). Polypharmacy, defined as ≥5 dispensed drug types yearly, was present in 30% of ACHD and 15% of referents {odds ratio [OR] = 2.47 [95% confidence interval (CI) 2.39–2.54]}. Polypharmacy was independently associated with female sex [OR = 1.92 (95% CI 1.88–1.96)], older age [for men: OR = 2.3/10 years (95% CI 2.2–2.4) and for women: OR = 1.6/10 years (95% CI 1.5–1.6); Pinteraction < 0.001], and ACHD severity [mild: OR = 2.51 (95% CI 2.40–2.61), moderate: OR = 3.22 (95% CI 3.06–3.40), severe: OR = 4.87 (95% CI 4.41–5.38)]. Cluster analysis identified three subgroups with distinct medication patterns; a low medication use group (8-year cumulative survival: 98%), and a cardiovascular and comorbidity group with lower survival (92% and 95%, respectively). Cox regression revealed a strong association between polypharmacy and mortality [hazard ratio (HR) = 3.94 (95% CI 3.22–4.81)], corrected for age, sex, and defect severity. Polypharmacy also increased the risk of hospitalization for adverse drug events [HR = 4.58 (95% CI 2.04–10.29)].ConclusionBoth cardiovascular and non-cardiovascular medication use is high in ACHD with twice as much polypharmacy compared with the matched general population. Patients with polypharmacy had a four-fold increased risk of mortality and adverse drug events. Recognition of distinct medication patterns can help identify patients at highest risk. Drug regimens need repeating evaluation to assess the appropriateness of all prescriptions. More high-quality studies are needed to improve ACHD care with more evidence-based pharmacotherapy.
Highlights
The adult congenital heart disease (ACHD) population is still growing and aging.[1,2] Healthcare utilization is high, and drugs are more often prescribed in ACHD than in controls.[3,4] Unlike other cardiovascular areas, evidence for drug therapy in ACHD is based on scarce clinical data and remains mostly empiric.[5]
It is known that the concurrent use of multiple medications, polypharmacy, is common (50%)[6] and it is generally accepted that increased drug therapy is associated with adverse outcomes, such as adverse drug events (ADEs), hospitalizations, and death.[7]
We aimed to identify patterns of medication use in ACHD and to analyse the association between polypharmacy and adverse outcomes in ACHD
Summary
The adult congenital heart disease (ACHD) population is still growing and aging.[1,2] Healthcare utilization is high, and drugs are more often prescribed in ACHD than in controls.[3,4] Unlike other cardiovascular areas, evidence for drug therapy in ACHD is based on scarce clinical data and remains mostly empiric.[5]. Pharmacological treatment in ACHD may start at a young age and may cumulate into chronic use of multiple medications. It is known that the concurrent use of multiple medications, polypharmacy, is common (50%)[6] and it is generally accepted that increased drug therapy is associated with adverse outcomes, such as adverse drug events (ADEs), hospitalizations, and death.[7] data on polypharmacy in ACHD are lacking. This study assessed medication use and polypharmacy in ACHD in comparison to the age- and sex-matched general population.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
