Prescription of Potentially Harmful Drugs in Young Adults With Heart Failure and Reduced Ejection Fraction

Abstract

According to national guidelines and statements drugs that can cause or exacerbate heart failure (HF) are considered potentially harmful and should be avoided if possible in patients with a diagnosis of heart failure with reduced ejection fraction (HFREF). To evaluate the prevalence of potentially harmful drug (PHD) prescription among patients with a diagnosis of systolic heart failure we conducted a retrospective cohort study using Truven Health MarketScan Commercial database from 2011 to 2014. Prescription of PHD as defined by American Heart Association Statement was examined among patients with a HFREF diagnosis in: (1) Two outpatient encounters, (2) One inpatient encounter as primary diagnosis and/or (3) one inpatient encounter any position and one outpatient encounter. Among 40,966 patients, 24.2% were prescribed with at least 1 drug with the potential to cause or exacerbate heart failure. Of the 9,954 patients prescribed with PHD, nonsteroidal anti-inflammatory agents were the most frequent category prescribed (67.4%), followed by antihypertensive (24%), diabetes mellitus (23.3%), neurological and psychiatric (21%) and antiarrhythmic medications (12.6%). After multivariable analysis female patients, the presence of a comorbidity associated with a PHD use and polypharmacy were more frequently prescribed a PHD. In conclusion almost ¼ of adult patients with a diagnosis of HFREF have a prescription of a drug with a potential to cause or exacerbate heart failure as defined by current heart failure guidelines.