Number of Medications Taken By Heart Failure Patients
As with many chronic conditions, there are several different drugs available to manage heart failure (HF). Some of these can be taken alongside one another for extra benefit.
However, when a person has more than 1 medical condition, the number of drugs needed can add up fast. In fact, it has been estimated that as many as 90 percent of people with HF who have Medicare insurance have 3 or more other health conditions alongside their HF. Further, 60 percent have 5 or more additional conditions.1
Finding the right drugs to manage all of these conditions can add up fast. This can lead to polypharmacy.
What is polypharmacy?
When a person takes many different drugs, it is often called polypharmacy. There is no strict definition of how many drugs a person can be on before this mark is met. Some consider 5 or more medicines taken together to be polypharmacy, while others suggest more.
There are several issues that come along with polypharmacy. First, the more drugs added to a person’s treatment plan, the greater the risk that these will interact and cause adverse (negative) side effects. In older adults, medicines are broken down and processed differently. This can further increase the risk of drug interactions. This can lead to falls, cognitive impairment, hospitalizations, disability, and more.
Plus, more drugs means more pills taken every day. This can become hard to manage and lead to treatment nonadherence. Treatment nonadherence is when a person is prescribed a drug but is not taking it to the full extent they are supposed to, leading to worsened health outcomes. Also, the more drugs added to a person’s plan, the more expensive their overall treatment becomes. Not being able to afford medicines can lead to nonadherence as well.
A recent study in the American Heart Association’s journal “Circulation: Heart Failure” suggests that people with HF are often prescribed so many drugs, their polypharmacy definition should be higher than normal. It suggests it should start at 10 drugs or more taken side-by-side.1
What did this polypharmacy study find?
This study on polypharmacy in people with HF looked at the medical charts of more than 550 adults across the United States between 2003 and 2014. These adults were all hospitalized for HF. Their medicines were reviewed at the time they entered the hospital, as well as at the time they were sent home (discharged).1
Overall, they found that nearly 85 percent of people in the study were prescribed 5 or more drugs when they arrived at the hospital. This number increased to 95 percent when they were sent home. Additionally, 42 percent came into the hospital with 10 or more prescribed drugs, which increased to 55 percent when they were sent home. This means that by the time a person was sent home from the hospital, they were prescribed more drugs than what they started with. Also, more than 50 percent left the hospital with prescriptions for 10 or more drugs.1
When looking at trends in the data, the researchers found that the number of people discharged with 10 or more drugs increased 20 percent from the time the study was started to the time it ended. This means that over time, more drugs continue to be prescribed to those with HF, and the risk of polypharmacy continues to increase.1
The researchers also looked at the types of drugs prescribed at discharge. They classified these into:1
- HF-related drugs
- Drugs to treat other heart conditions
- Non-heart-related drugs
Overall, the greatest increase in prescriptions was among non-heart-related drugs. This includes drugs for other issues like diabetes and lung or kidney problems. All of these results were similar when comparing people with HF with reduced and preserved ejection fractions (HFrEF and HFpEF).1
What can be done?
The researchers suggest that the risk of adverse side effects, drug interactions, and other problems increases with more medicines. They also suggest that the traditional cut-off for polypharmacy may not be helpful in HF care, since the number of drugs prescribed can be quite high.
Ultimately, they suggest that reviewing all drugs on hospital admission and discharge is critical. This includes both HF and non-HF drugs, since stopping unnecessary drugs can improve quality of life. If certain drug types cannot be stopped, switching to different drugs with the same function but less potential side effects may also be helpful.
Although this study looked at people using Medicare insurance with HF and may not completely reflect polypharmacy for everyone, it does highlight an important part of navigating life with HF and how treatment planning can be improved.
If you are concerned about the number of medicines you are currently taking, talk to your doctor before making any changes.
Have you ever avoided going to the doctor out of fear?