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Use of Potentially Harmful Drugs among Medicare Beneficiaries with Heart Failure and Reduced Ejection Fraction: Impact on Readmissions and Mortality
Abstract   Open access   Peer reviewed

Use of Potentially Harmful Drugs among Medicare Beneficiaries with Heart Failure and Reduced Ejection Fraction: Impact on Readmissions and Mortality

Paulino Alvarez, Alexandros Briasoulis, Saket Girotra, Chakradhari Inampudi, Amgad Mentias and Mary Vaughan-Sarrazin
Journal of cardiac failure, Vol.25(8), pp.S132-S133
08/2019
DOI: 10.1016/j.cardfail.2019.07.380
url
https://doi.org/10.1016/j.cardfail.2019.07.380View
Published (Version of record) Open Access

Abstract

Multiple cardiac and non-cardiac drugs have the potential to exacerbate heart failure (HF). Information regarding prevalence of their use among elderly patients with HF is scarce. This study sought to analyze the prevalence and clinical impact of potentially harmful drugs prescriptions as defined in current HF guidelines among elderly patients discharged after a hospitalization for heart failure and reduced ejection fraction (HFrEF). We utilized Centers for Medicare & Medicaid data files from a nationally representative 5% sample for the years 2014-2016 to identify patients admitted with primary diagnosis of HFrEF. To be included in our analysis, patients had to fill a prescription for angiotensin converting enzyme inhibitor, angiotensin receptor blocker or angiotensin receptor-Neprylisin inhibitor and a beta-blocker after discharge. Patients were subsequently divided according to the presence or absence of a prescription for a potentially harmful drug. A total of 9,941 patients were included in the study. Potentially harmful drugs were prescribed in 1208 (12.1%) patients within 90 days of HF hospitalization. Non-steroidal anti-inflammatory agents were the most frequently prescribed potentially harmful drugs (6.76%) followed by calcium channel blockers (4.9%), thiazolidinedione (0.66%) and antiarrhythmics (0.35%). Factors associated with potentially harmful drug prescription included female gender, Hispanic ethnicity, severe obesity, hypertension, atrial fibrillation and chronic lung disease. In multivariable analysis the prescription of a potentially harmful drug was significantly associated with increased hospital readmissions (odds ratio 1.14; 95% Confidence Intervals 1.06, 1.22).There was no evidence of increased risk of mortality. Approximately 1 in 10 patients admitted with a primary diagnosis of Heart Failure with Reduced Ejection Fraction is prescribed a potentially harmful drug within 90 days of discharge and this is associated with increased risk of hospital readmission.

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