Older Heart Failure Patients Have Higher Risk of Polypharmacy

Pharmacists and other health care providers use the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults as a guideline for prescribing medications for older adults.

When seniors start taking medications identified on this list, prescribers often begin deprescribing to avoid problems associated with polypharmacy, drug interactions, and adverse drug reactions.

Revised periodically, the list’s most recent iteration was published in 2015.

Researchers from the University of Saint Joseph in West Hartford, Connecticut, and the University of Connecticut showed concern about the increasing incidence of heart failure and its medication burden, so they set out to determine how heart failure patients handle it.

Since the majority of heart failure patients are elderly (the average age in this study was 81), it is likely that some of their medications may be contraindicated.

The study published ahead-of-print in the Journal of Cardiovascular Nursing indicated that heavy pill burden and insufficient patient education are increasing risks for these patients.

The Beers Criteria identifies medications that increase fall risk, and it notes that concurrent use of 3 or more central nervous system drugs is troublesome for seniors.

All 41 patients who participated in the study took at least 5 medications daily. Overall, participants took an average of 12.6 medications requiring multiple daily doses.

Approximately three-quarters of the patients were prescribed at least 1 medication not recommended on the Beers Criteria, and half of them took at least 2.

Among patients taking medications not recommended by the Beers Criteria, half reported symptoms, with falls being the most common.

Unsteadiness, near falls, fatigue, dizziness, leg cramps, and constipation were common drug-induced problems.

More than half of American hospitals have been docked pursuant to Medicare’s readmission penalties due to patient readmission within 30 days of heart failure-related discharge.

Polypharmacy has contributed to emergency department visits and hospitalizations. Warfarin and oral antiplatelet agents are the drugs most often implicated in readmission.

The researchers also found that 95% of patients surveyed in this study were taking medications with anticholinergic adverse effects that increased their risk of cognitive impairment.