Polypharmacy and Distinctive Demographics of Congestive Heart Failure Patients
Seenu Abraham1, Peter Vayalil1, Sagar Patel1, Tim Quinn1, Jeffrey Hackman1,2, Lawrence Dall1,2
1UMKC School of Medicine, 2Truman Medical Center
INTRODUCTION
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Polypharmacy is a growing problem in modern medicine,
especially in patients with Congestive Heart Failure (CHF) as it
increases their overall morbidity and mortality (1)
US Center for Medicare and Medicaid Services estimates that
polypharmacy costs its nation’s health plans more than US$50
billion annually (2)
Complications arising from polypharmacy include: increased
drug interactions, more adverse reactions to medications,
complication of management of medical conditions,
noncompliance, and formation of prescribing cascade
This project examined the issue of polypharmacy in the
patient populations of Truman Medical Centers (TMC), an
urban hospital in Kansas City, Missouri.
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CONCLUSION/FUTURE DIRECTION
RESULTS
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Average age of CHF patients: 58.3 years (SD 12.3)
Average number of medications: 13 medications (SD 5.5)
• EF<30% = 11.4 medications (SD 4.81)
• EF>30% = 13.7 medications (SD 5.73)
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METHODS
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Using an IRB approved retrospective chart review
analysis, patients at TMC who were diagnosed with CHF
with documented echocardiograms were identified
Patients with diagnosis of CHF but no echocardiograms,
age, or number of medications recorded were excluded
from the initial data group, which included 644 patients.
Using basic descriptive statistics , these 1,165 patients
were analyzed and categorized based on their ejection
fraction (EF) > or < 30% and number of current
medications.
Patients were identified as meeting criteria for
polypharmacy if they were taking at least 5 or more
medications (3)
Through this study, we hope to better understand the problem
of polypharmacy in TMC patients. We wanted to initially
determine the severity of the problem. Having done so, we
now hope to determine the major sources of this problem and
identify any sources of error that can be eliminated to
decrease the problem of polypharmacy.
The reasons for the lower age in our population will be further
explored to see how the pathogenesis of CHF in this urban
population is different.
Determine cause of such a low age for TMC CHF patients
• Ongoing retrospective chart review to determine if
non-ischemic causes are contributing to CHF in our
patients.
Further quantify clinic visits, number of (re)admissions,
hospital stay length and related deaths in this population
Create a timeline of medication addition and discontinuation.
LIMITATIONS
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SUMMARY
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CHF patients at TMC had a lower mean age of 58.3 years old
compared to regional and national averages (4, 5). These
patients are prescribed an average of 13 medications, reaching
well above the criteria set for polypharmacy.
This pilot study illustrates the problem of polypharmacy of
CHF in this urban population.
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This pilot study was conducted with patient information from
a single center.
There are currently various definitions of polypharmacy in
the literature.
CREDITS/DISCLOSURE/REFERENCES
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Jyrkkä, J., et al. “Polypharmacy Status as an Indicator of Mortality in an Elderly Population.” Drugs & Aging.
2009; 26:1039.
Berry, C., et al. “Economics of Chronic Heart Failure.” European Journal of Heart Failure. 2001; 3:283–91.
Mastromarino, V., et al. “Polypharmacy in Heart Failure Patients.” Current Heart Failure Reports. 2014;
11:212-9.
Klug, M., et al. Geographic Differences in Potentially Preventable Readmisssion Rates in Rural and Urban
Hospitals. Executive Summary 12. Upper Midwest Rural Health Research Center. 2010.
http://ruralhealth.und.edu/pdf/umrhrc_finalreport1110.pdf. Last accessed on 03/16/2015.
Heart Failure Statistics. Emory Healthcare Website. 2015. http://www.emoryhealthcare.org/heartfailure/learn-about-heart-failure/statistics.html. Last accessed on 03/16/2015.