Polypharmacy linked to functional impairment in seniors with HF

Seniors taking five or more prescription drugs to treat heart failure could be at an increased risk for functional impairment, according to a study published in the Journal of the American Geriatrics Society.

Polypharmacy—a cocktail of at least five different medications that patients take to manage chronic health conditions—is common in 2018, first author Parag Goyal, MD, MSc, and colleagues wrote. But it can also contribute to other issues, like falls and hospitalizations, and many patients still struggle to perform their routine daily activities, or ADLs (activities of daily living).

Goyal and co-authors used 2003-2014 National Health and Nutrition Examination Survey data to assess 947 patients aged 50 or older with self-reported heart failure. The majority of participants were around 70 years old, and the population took an average of 7.2 unique medications per day.

The researchers found 74 percent of patients were taking five or more medications, which wasn’t surprising since those enrolled in the study had multiple chronic conditions like diabetes, anemia, prior MI and cancer and were considered to be frail. Nearly a quarter of patients reported experiencing cognitive difficulties, which is common in people who also have problems performing ADLs.

Goyal et al. said ADL impairment wasn’t independently associated with medication count in a multivariable model, but patients who had difficulties with ADLs were more likely to be taking more than five medications compared to participants who could perform ADLs easily. The authors said their findings might be an indicator that physicians aren’t taking ADL limitations into account when prescribing drugs for older patients with heart failure.

“After adjusting for confounders including comorbidity, we found that adults with heart failure and ADL impairment take as many medications as those without ADL impairment,” the team wrote. “This suggests that providers may not sufficiently consider functional impairment when prescribing medications to adults with heart failure and thus may unnecessarily expose individuals to risk of adverse outcomes.”