AHA releases list of drugs that may cause or exacerbate heart failure

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Patients with heart failure take an average of 6.8 prescription medications per day. And that estimate from researchers does not even include over-the-counter, complementary and alternative medications.

By relying on so many drugs to treat their disease, patients are putting themselves at risk of medical issues, according to a scientific statement released on July 11 from the American Heart Association (AHA). The statement was published online in Circulation.

The statement outlined for the first time drugs that may cause or exacerbate heart failure, which is the leading discharge diagnosis for patients who are 65 years old or older. Treating heart failure among Medicare patients costs an estimated $31 billion per year, according to the researchers. By 2030, the costs are expected to rise to $53 billion.

Robert L. Page, PharmD, the chair of the AHA’s writing committee, said most patients with heart failure fall under a category known as polypharmacy. He defined polypharmacy as the long-term use of at least five medications.

Previous research showed that 40 percent of Medicare patients with heart failure have five or more cardiovascular and noncardiovascular comorbidities. Meanwhile, only 7.6 percent of the general Medicare population has three or more chronic conditions.

Medicare beneficiaries with heart failure see 15 to 23 different providers each year, which the researchers said contributes to them receiving more medications and possibly experiencing adverse drug events and drug-drug interactions.

“In geriatrics, it’s very common to see polypharmacy,” Page told Cardiovascular Business in a telephone interview. “Polypharmacy has been a problem, I would say for the last 30 years if you go back and look at the literature. I’ve been practicing for 20 years, and it’s been an issue. As long as we’ve had drugs, I think there’s been issues with polypharmacy, especially when you mix in over-the-counter and herbal supplements.”

The AHA’s committee for this scientific committee included pharmacists, specialists in heart failure, an anesthesiologist and other healthcare providers. Page and his colleagues examined more than 300 prospective and observational trials, case series, package inserts and meta-analyses.

They selected medications based on their potential to cause an adverse drug event, which they defined as death, an increase in health resources, a change in New York Heart Association heart failure class, cardiac function or cardiovascular disease.

They found that numerous medications may cause or exacerbate heart failure and grouped them into the following categories: analgesics, anesthesia medications, diabetes medications, antiarrythmic medications, antihypertensive medications, anti-infective medications, anti-cancer medications, hematologic medications, neurological and psychiatric medications, opthalomogical medications, pulmonary medications, rheumatological medications, urological agents, over-the-counter medications and complementary/alternative medications.

Page suggested that heart failure patients keep a list of all of the medications they are taking and provide the information to their healthcare providers. He also said patients need to understand the benefits, side effects and dosages of their medications and discuss any issues with their doctors and pharmacists.

“You would hope that providers and specialists communicate with each other,” said Page, a clinical pharmacist and professor at the University of Colorado schools of pharmacy and medicine. “But we know in today’s world, that that sometimes doesn’t always happen. It does fall sometime on the patient to make sure that there is some kind of communications and that patients really accept the responsibility of their medication management.”