Polypharmacy In Heart Failure Research Articles

Definition of Polypharmacy in Heart Failure: A Scoping Review of the Literature.

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.

Research into glucose-lowering drugs for heart failure treatment.

British Journal of Community NursingVol. 24, No. 11 TreatmentsResearch into glucose-lowering drugs for heart failure treatmentAysha MendesAysha MendesE-mail Address: [email protected]Freelance journalist specialising in healthcare and psychologySearch for more papers by this authorAysha MendesPublished Online:1 Nov 2019https://doi.org/10.12968/bjcn.2019.24.11.560AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management [NG106]. 2018. www.nice.org.uk/guidance/ng106 (accessed 24 October 2019) Google ScholarNeal B, Perkovic V, Mahaffey KW et al.; CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377:644–657. https://doi.org/10.1056/NEJMoa1611925 Crossref, Medline, Google ScholarNHS. Overview: heart failure. 2018. https://www.nhs.uk/conditions/heartfailure/ (accessed 18 October 2019) Google ScholarPasternak B, Ueda P, Eliasson et al. Use of sodium glucose cotransporter 2 inhibitors and risk of major cardiovascular events and heart failure: Scandinavian register based cohort study. BMJ. 2019; 366:l4772. https://doi.org/10.1136/bmj.l4772 Crossref, Medline, Google ScholarRushton CA, Kadam UT. Polypharmacy in heart failure: a growing challenge. Br J Cardiac Nurs. 2011; 6(5):214–220. https://doi.org/10.12968/bjca.2011.6.5.214 Link, Google ScholarSharp J, McCowat M. Depression in heart failure. Br J Cardiac Nurs. 2019; 14(6):1–11. https://doi.org/10.12968/bjca.2019.0011 Link, Google ScholarWiviott SD, Raz I, Bonaca MP et al.; DECLARE–TIMI 58 Investigators. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380:347–357. https://doi.org/10.1056/NEJMoa1812389 Crossref, Medline, Google ScholarZelniker TA, Wiviott SD, Raz I et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019; 393:31–39. https://doi.org/10.1016/S0140-6736(18)32590-X Crossref, Medline, Google ScholarZinman B, Wanner C, Lachin JM et al.; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373:2117–2128. https://doi.org/10.1056/NEJMoa1504720 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 November 2019Volume 24Issue 11ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 1 November 2019 Published in print 2 November 2019 Information© MA Healthcare LimitedPDF download

Polypharmacy in heart failure — Is reducing medication safe?

Article history: Received 28 June 2015 Accepted 24 September 2015 Available online 31 January 2016 were required. Standard HF clinical status and quality of life (QoL) endpoints were evaluated, including the Cardiac Depression Scale (CDS), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short Form (36) Health Survey (SF-36). Groups were compared using two-tailed paired t-test. Institutional ethics approval was obtained, each patient provided informed consent, and the studies conformed to the ethical guidelines of the Declaration of Helsinki. Registration num-

Polypharmacy in heart failure: drugs to use and avoid.

Polypharmacy, the use of 4 or more medications, is universal in patients with heart failure (HF). Evidence-based combination therapy is prescribed in patients with HF with reduced ejection fraction (HFrEF). Additionally, treatment of the high prevalence of comorbidities presents many therapeutic dilemmas. The use of nonprescription medications is common, adding further complexity to the medication therapy regimens of patients with HF. An approach for combining evidence-based therapies in patients with HFrEF is presented. Strategies for optimizing the management of common comorbidities in patients with HF are reviewed. Both prescription and nonprescription medications to avoid or use with caution are highlighted.

Comorbidities and Polypharmacy

Heart failure (HF) is predominantly a disease that affects the elderly population, a cohort in which comorbidities are common. The majority of comorbidities and the degree of their severity have prognostic implications in HF. Polypharmacy in HF is common, has increased throughout the past 2 decades, and may pose a risk for adverse drug interactions, accidental overdosing, or medication nonadherence. Polypharmacy, in particular in the elderly, is rarely assessed in traditional clinical trials, highlighting a need for entirely novel HF research strategies.

Polypharmacy in heart failure: A growing challenge

Current guidelines in heart failure recommend ‘add-on’ prescribing of evidence-based medicines aimed at improving symptoms and prognosis. Heart failure patients therefore commonly receive multiple drug therapies and this ‘polypharmacy’ is set to increase with the recognition of new potential drug targets. Drug regimes in heart failure are further complicated by increasing age and high levels of comorbidity inherent in this patient group. Nurses are central to the patient's care pathway and the commencement and titration of medicines are key component sof the patient's management plan. The development of nursing specialism in heart failure alongside independent prescribing have further extended nurse's responsibilities. Polypharmacy is an important consideration for nursing and this article provides an overview of the development of drug therapies in heart failure as well as the scope of polypharmacy for this group. The key implications of polypharmacy in heart failure will be explored, including side effects, drug interactions, prescription errors, optimal clinical prescribing and patient adherence.

Trends in Comorbidity, Disability, and Polypharmacy in Heart Failure

Background Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population. Methods Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988-1994, 1999-2002, 2003-2008). Results We identified 1395 participants with self-reported heart failure (n = 581 in 1988-1994, n = 280 in 1999-2002, n = 534 in 2003-2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 ( P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% ( P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions ( P <.01). The prevalence of disability did not increase but was substantial across all years. Conclusion The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.

The problem of polypharmacy in heart failure

Improvements in the medical therapy for chronic heart failure have led to a dramatic decrease in the morbidity and mortality of patients with heart failure over the past two decades. This improvement has been gained at the expense of an increasing number of potent drugs that heart failure patients have to take chronically. Because heart failure forms the end-stage of different cardiovascular diseases and their predisposing risk factors, patients need drug treatment not only for heart failure itself but also for related conditions. Even more, because most heart failure patients are elderly, a number of unrelated, noncardiovascular diseases become apparent, which further increase the number of pharmaceutical substances with which heart failure patients are treated. The resulting polypharmacy leads to problems including economic burden, patient compliance, and most importantly, partly unpredictable drug interactions. This article reviews the existing data concerning some of these problems, to provide an aid for choosing the appropriate drugs in heart failure patients and minimizing the patient's risk.

Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug-interactions.

There is growing concern at the nature and extent of polypharmacy in heart failure (HF), which may be associated with increased drug interactions, adverse drug effects and a poor understanding of and compliance with therapy. This study evaluates polypharmacy in a relatively unselected community heart failure population following emergency admission and determines the impact of an in-hospital, specialist heart failure care programme on appropriate pharmacotherapy, polypharmacy and drug interactions. We analysed the medication profiles of 91 consecutive patients with an emergency admission for HF to our institution on admission and discharge. The numbers of inappropriate medicines, inappropriate dosages and omitted medicines according to guidelines were recorded. Medication profiles were analysed for potential drug-drug, drug-liver and drug-kidney interactions using standard criteria. In the study population, average age 71.1+/-10.4 years, 65.9% were male, 68.1% had left ventricular systolic dysfunction and the average ejection fraction on transfer to the specialist HF service was 38+/-13%. A total of 66 inappropriate medicines, 107 omitted medicines and 37 inappropriate dosage regimens were identified in the cohort on admission. These figures had dropped to 31, 33 and 19, respectively, on discharge, with per patient averages decreasing significantly (all P<0.0001). However, polypharmacy and potential drug interactions increased by 33% and 62%, respectively, from admission to discharge (P<0.0001) as did drug-kidney interactions and drug-liver interactions. Only ischemic aetiology and hypercholesterolaemia predicted polypharmacy in this cohort on discharge, whereas age, sex, renal function and heart failure type did not. Specialist care of heart failure following emergency admission results in more appropriate pharmacotherapy of heart failure. However, increased polypharmacy and drug-interactions are an inevitable consequence independent of age, sex and renal function. We advocate a practice of systematic evaluation of polypharmacy in all heart failure patients to identify potential problems and modify therapy where appropriate.

Combination Drug Therapy in Patients with Heart Failure: Tenets of Rational Polypharmacy.

Combining drugs to treat patients with heart disease is common. It is important to assess this practice with respect to sound principles of therapeutics and review what has become a complicated and challenging practice, combining drugs to treat heart failure. The purpose of this review is to consider the philosophy of polypharmacy in heart failure and formulate specific recommendations regarding the creation of a rational pharmacologic approach to these patients.