42% of HF patients take at least 10 meds a day—and they’re willing to add more

Nearly half of patients with heart failure (HF) take at least 10 medications per day, according to research published in the American Journal of Cardiology, yet an overwhelming 85 percent report willingness to add more drugs to that regimen if it helps them prevent further health events.

Adults with HF are typically prescribed a complex cocktail of medications to manage their condition, senior author Emily B. Levitan, ScD, of the University of Alabama at Birmingham, and colleagues wrote in AJC. That regimen often includes beta-blockers—especially in the case of heart failure with reduced ejection fraction—to treat HF as well as a host of common comorbidities like hypertension, arrhythmias and coronary heart disease.

“Medication regimens among adults with HF are complex, which can complicate patient adherence,” Levitan and co-authors wrote. “A better understanding of overall treatment burden and knowledge of beta-blocker use among adults with HF may help direct future interventions to optimize medical management.”

The researchers mailed a survey on medication use to thousands of patients enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, eventually receiving 518 responses. Of those respondents, 69 percent reported taking a beta-blocker.

Despite a high incidence of polypharmacy in the study cohort—42 percent of patients reported taking 10 or more medications per day to manage their disease—45 percent of participants said they didn’t miss any days of taking their medications. In addition, 85 percent said they’d be willing to take additional pills if they would circumvent future complications.

“Most participants reported a willingness to take an additional pill if it prevented a further healthcare encounter,” the authors wrote. “This suggests that many individuals are willing to try additional therapies to improve their HF, and pill burden and potential side effects may not be a major barrier to treatment adherence in a motivated population.”

Levitan et al.’s finding wasn’t exactly novel—a 2018 study found adults with HF take an average of 7.2 medications per day, and a high incidence of polypharmacy is expected in a population with so many comorbidities. But their research went further, exploring patients’ attitudes about taking beta-blockers.

The team found 56 percent of patients who reported experiencing beta-blocker side effects like weakness, nausea, dizziness and drowsiness didn’t discuss the symptoms with their doctors. Patients who were hospitalized with HF were 51 percent more likely to be taking a beta-blocker, and adults with hypertension were more than twice as likely.

Levitan and colleagues said their results were consistent with prior studies that found patients with chronic diseases avoid talking to their medical providers about the perceived side effects of some medications.

“As far as we know, this is one of few studies to examine HF in particular and behavior as it relates to a commonly prescribed agent for individuals with HF, irrespective of subtype,” the authors wrote. “With national efforts focused on increasing the use of guideline-directed medical therapy for HF, this study adds to the literature by shedding light on practical issues that underlie medication-taking behavior and the subsequent benefits (and potential harms) of their use.

“Discussing potential medication side effects related to HF treatments may facilitate more meaningful patient-provider interactions and ultimately help optimize treatment for HF.”