Journal article
Potentially harmful drug prescription in elderly patients with heart failure with reduced ejection fraction
ESC Heart Failure, Vol.7(4), pp.1862-1871
08/01/2020
DOI: 10.1002/ehf2.12752
PMCID: PMC7373931
PMID: 32419388
Abstract
Aims This study aimed to evaluate the prescription frequency of potentially harmful prescription drugs as defined in current heart failure guidelines among elderly patients with a diagnosis of heart failure with reduced ejection fraction and their association with clinical outcomes.
Methods and results We used the Centers for Medicare & Medicaid Services data from a nationally representative 5% sample for the years 2014-2016 to identify patients admitted to acute care hospitals with a primary diagnosis of heart failure with reduced ejection fraction. The primary exposure was filling a prescription for a potentially harmful drug. Potentially harmful drug fills were treated as a time-dependent covariate to examine their association on readmission and mortality. A total of 8993 patients met study criteria. Potentially harmful drugs were prescribed in 1077 (11.9%) patients within 90 days of discharge from the heart failure hospitalization. Non-steroidal anti-inflammatory agents were the most frequently prescribed potentially harmful drug (6.7%) followed by calcium channel blockers (4.7%), thiazolidinedione (0.59%), and select antiarrhythmic (0.33%). Factors independently associated with potentially harmful drug prescription were female gender, Hispanic ethnicity, severe obesity, among others. In the multivariable Cox model, the prescription of a potentially harmful drug was associated with an increased risk of readmission (hazard ratio 1.14; 95% confidence interval 1.05-1.23, P < 0.001). Among drug subgroups, only calcium channel blockers were associated with an increased risk of readmission (hazard ratio 1.225; 95% confidence interval 1.085-1.382, P = 0.0011).
Conclusions In elderly patients discharged with a primary diagnosis of heart failure with reduced ejection fraction on guideline-directed medical therapy, prescription of a potentially harmful drug was frequent. Calcium channel blockers were associated with an increased risk of readmission.
Details
- Title: Subtitle
- Potentially harmful drug prescription in elderly patients with heart failure with reduced ejection fraction
- Creators
- Paulino A. Alvarez - University of IowaYubo Gao - University of IowaSaket Girotra - University of Iowa Hospitals and ClinicsAmgad Mentias - University of Iowa Hospitals and ClinicsAlexandros Briasoulis - University of IowaMary S. Vaughan Sarrazin - Univ Iowa, Inst Clin & Translat Sci, 200 Hawkins Dr,C44-GH, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- ESC Heart Failure, Vol.7(4), pp.1862-1871
- DOI
- 10.1002/ehf2.12752
- PMID
- 32419388
- PMCID
- PMC7373931
- NLM abbreviation
- ESC Heart Fail
- ISSN
- 2055-5822
- eISSN
- 2055-5822
- Publisher
- Wiley
- Number of pages
- 10
- Grant note
- K08HL122527; I21HX002365 / U.S. Department of Veterans Affairs; US Department of Veterans Affairs Health Services Research and Development Service (HSR&D) of the U.S. Department of Veterans Affairs R01AG055663-01 / National Institute on Aging (NIA); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Language
- English
- Date published
- 08/01/2020
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359908602771
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