Pharmacists Should Regularly Review Medications for Older Patients with 10 or More Prescriptions

A new study has found that more than half of older patients hospitalized for heart failure are discharged with 10 or more prescriptions, putting them at significant risk for harm related to high medication burden.

According to the research, published in Circulation: Heart Failure, investigators examined the medical charts of 558 adults aged 65 years and older who were covered by Medicare and hospitalized for heart failure between 2003 and 2014. All of the patients were participants in the ongoing Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationwide prospective cohort of more than 30,000 participants that began in 2003.

“High medication burden, also known as polypharmacy, is commonly associated with adverse events and reactions,” said senior study author Parag Goyal, MD, MSc, in a press release. “As the treatment options for various conditions including heart failure expand and the population ages, it is becoming increasingly important to weigh the risks and possible benefits of multiple medications.”

Significantly, the authors found that upon hospital admission, 84% of the participants took 5 or more medications and 42% took 10 or more medications. All participants were discharged with more prescriptions than they had upon admission, with 95% prescribed 5 or more medications and 55% prescribed 10 or more at discharge. Furthermore, the investigators found that most of the medications taken by participants with heart failure were not to treat a heart condition at all.

The authors noted that the study was conducted prior to the approvals of several new heart failure medications, meaning the number of patients with heart failure who are prescribed 10 or more medications may be even higher today. Polypharmacy has become increasingly common in recent decades, with just 41% of patients prescribed 10 or more medications at discharge between 2003 and 2006, compared with 68% of patients discharged between 2011 and 2014.

“The medication burden for older adults with heart failure was higher following a heart failure hospitalization,” Goyal said in a press release. “Some of these drugs may be appropriate. However, our prior work has shown that many patients are discharged with prescriptions for medications that can worsen heart failure. This supports the ongoing need for improved and routine medication review processes prior to hospital discharge, and particularly in the immediate post-discharge period where the risk of hospital readmission is particularly high.”

Although advances in medications can expand treatment options, the authors emphasized that people with heart failure taking 10 or more medications may be especially at risk of negative interactions.

“Our findings support the need to tailor decisions related to medication prescribing for each patient while considering their overall health status,” Goyal concluded. “The key to managing polypharmacy is medication review during each appointment. With regular review, the hope is that the right medications—where the possible benefit outweighs the risks—will be started or continued, and if the risks outweigh possible benefits, those medications are discontinued.”

REFERENCE

Ten or more medications, often prescribed to older heart failure patients, raises concerns [news release]. American Heart Association; October 13, 2020. https://newsroom.heart.org/news/ten-or-more-medications-often-prescribed-to-older-heart-failure-patients-raises-concerns?preview=6a4e. Accessed October 19, 2020.