Abstract
BackgroundWhile an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF.MethodsWe studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003–2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF.ResultsThe prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy.ConclusionHyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
Highlights
While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, [1, 2] this has been accompanied by an increase in the number of medications taken by adults with HF
[16] we sought to examine a nationally-representative cohort of adults with HF using the National Health And Nutrition Examination Survey (NHANES) data to better understand the prevalence of hyperpolypharmacy and identify its determinants among this vulnerable population
[10] This is consistent with a recent study of HF patients, where we showed that those with functional impairment take the same number of medications as those without functional impairment when adjusting for other factors like comorbidity burden, even when factors like cognitive impairment, low self-reported health, and recurrent hospitalizations are present
Summary
While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is notable given its association with adverse outcomes. The use of at least 10 medications is notable, representing a condition described in the Geriatrics and Pharmacology literature as hyperpolypharmacy. [12] Despite the high burden of medication use among adults with HF, the concept of hyperpolypharmacy may be overlooked This is potentially problematic, as adults with HF represent a subgroup at high risk for medication-related adverse outcomes due to alterations in pharmacokinetics and pharmacodynamics, [13] changes in cardiovascular structure and function, [14] and the coexistence of geriatric conditions like frailty [15] and cognitive impairment. This is potentially problematic, as adults with HF represent a subgroup at high risk for medication-related adverse outcomes due to alterations in pharmacokinetics and pharmacodynamics, [13] changes in cardiovascular structure and function, [14] and the coexistence of geriatric conditions like frailty [15] and cognitive impairment. [16] we sought to examine a nationally-representative cohort of adults with HF using the National Health And Nutrition Examination Survey (NHANES) data to better understand the prevalence of hyperpolypharmacy and identify its determinants among this vulnerable population
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