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Multidrug and optimal heart failure therapy prescribing in older general practice populations: a clinical data
Claire A Rushton1, Anna Strömberg, Tiny Jaarsma
1School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK.
Insights
Patients with heart failure (HF) often receive more medications, but this does not necessarily lead to suboptimal prescribing of essential cardiovascular disease (CVD) treatments. This study found higher multidrug therapy in HF patients without impacting optimal drug prescribing.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of morbidity and mortality globally.
- Heart failure (HF) is a complex condition often requiring management with multiple medications (multidrug therapy).
- The relationship between extensive medication regimens and optimal prescribing for HF within the broader CVD population requires investigation.
Purpose of the Study:
- To examine the prevalence of multidrug therapy in patients with cardiovascular disease (CVD).
- To determine if patients with heart failure (HF) experience suboptimal drug prescribing.
- To assess the association between multidrug therapy and optimal drug prescribing in HF patients.
Main Methods:
- A population-based, cross-sectional study utilizing linked clinical data from three general practices.
- 3155 patients aged 50+ with CVD diagnoses were analyzed over a 2-year period.
- Multidrug therapy was categorized by the number of distinct drug classes prescribed; optimal HF therapy was defined by ACE inhibitor (ACEi) or ACEi/β-blocker use.
Main Results:
- Heart failure (HF) patients exhibited significantly higher rates of multidrug therapy (≥7 drug classes) compared to non-HF CVD patients (26% vs. 14%).
- Prescribing of optimal HF treatments, including ACE inhibitors (ACEi) or combined ACEi and β-blocker therapy, was significantly associated with the HF group (OR 3.89 and 1.99, respectively).
- These associations remained significant after adjusting for sociodemographic factors and multidrug counts, indicating no negative impact of polypharmacy on optimal HF prescribing.
Conclusions:
- Multidrug therapy is more prevalent in patients with heart failure (HF) compared to other cardiovascular disease (CVD) populations.
- High levels of multidrug therapy in HF patients did not appear to compromise the prescribing of guideline-recommended optimal drug treatments.
- Further research could explore patient adherence and outcomes in this complex prescribing landscape.
Objective:
To investigate multidrug therapy in the cardiovascular disease (CVD) population and whether it was associated with suboptimal drug prescribing in heart failure (HF).
Design:
A population-based cross-sectional clinical data linkage study.
Setting:
The clinical database populations were registered with three general practices in North Staffordshire that are part of a research network.
Participants:
3155 patients aged 50 years and over were selected on the basis of a CVD-related prescription and a CVD consultation code applied to their electronic medical record in a 2-year time period. All available diagnostic data were linked to all drugs prescribed data during this time period. Two study groups were: (1) HF and (2) non-HF CVD (reference group).
Exposure:
A standard drug formulary system was used to define four multidrug count categories based on the number of different British National Formulary drug chapters prescribed at the same time.
Primary And Secondary Outcome Measures:
Optimal HF therapy was defined as the prescribing of ACE inhibitor (ACEi) or a combination of ACEi and β-blocker in the 2-year time window. An additional three specific CVD drug categories that are indicated in HF were also measured.
Results:
The HF group, compared with the reference group, had higher non-CVD multidrug therapy (26% with 7 or more counts compared with 14% in the non-HF CVD reference group). For the first-choice optimal drug treatment for HF with ACEi (64%) or ACEi and β-blocker combined therapy (23%), the multidrug-adjusted associations between the HF group and the reference group were OR 3.89; 95% CI 2.8 to 5.5 and 1.99; 1.4 to 2.9, respectively. These estimates were not influenced by adjustment for sociodemographic factors and multidrug counts.
Conclusions:
Multidrug therapy prescribing is much higher in the HF group than in a comparable CVD group but did not influence optimal drug prescribing.
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