Author + information
- Received May 30, 2019
- Revision received August 2, 2019
- Accepted August 6, 2019
- Published online November 6, 2019.
- Parag Goyal, MD, MSca,b,∗ (, )@ParagGoyalMD,
- Jerard Kneifati-Hayek, MDc,
- Alexi Archambault, MPHb,
- Krisha Mehta, BAd,
- Emily B. Levitan, ScDe,
- Ligong Chen, PhDe,
- Ivan Diaz, PhDf,
- James Hollenberg, MDb,
- Joseph T. Hanlon, PharmD, MSg,
- Mark S. Lachs, MD, MPHh,
- Mathew S. Maurer, MDi and
- Monika M. Safford, MDb
- aDivision of Cardiology, Weill Cornell Medicine, New York, New York
- bDivision of General Internal Medicine, Weill Cornell Medicine, New York, New York
- cDivision of General Internal Medicine, Columbia University Medical Center, New York, New York
- dSchool of Medicine at Stony Brook University, Stony Brook, New York
- eDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- fDepartment of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
- gDepartment of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- hDivision of Geriatrics, Weill Cornell Medicine, New York, New York
- iDivision of Cardiology, Columbia University Medical Center, New York, New York
- ↵∗Address for correspondence:
Dr. Parag Goyal, Divisions of Cardiology and General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, New York 10021.
Objectives This study sought to describe the patterns of heart failure (HF)-exacerbating medications used among older adults hospitalized for HF and to examine determinants of HF-exacerbating medication use.
Background HF-exacerbating medications can potentially contribute to adverse outcomes and could represent an important target for future strategies to improve post-hospitalization outcomes.
Methods Medicare beneficiaries ≥65 years of age with an adjudicated HF hospitalization between 2003 and 2014 were derived from the geographically diverse REGARDS (Reasons for Geographic and Racial Difference in Stroke) cohort study. Major HF-exacerbating medications, defined as those listed on the 2016 American Heart Association Scientific Statement listing medications that can precipitate or induce HF, were examined. Patterns of prescribing medications at hospital admission and at discharge were examined, as well as changes that occurred between admission and discharge; and a multivariable logistic regression analysis was conducted to identify determinants of harmful prescribing practices following HF hospitalization (defined as either the continuation of an HF-exacerbating medications or an increase in the number of HF-exacerbating medications between hospital admission and discharge).
Results Among 558 unique individuals, 18% experienced a decrease in the number of HF-exacerbating medications between admission and discharge, 19% remained at the same number, and 12% experienced an increase. Multivariable logistic regression analysis revealed that diabetes (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18 to 2.75]) and small hospital size (OR: 1.93; 95% CI: 1.18 to 3.16) were the strongest, independently associated determinants of harmful prescribing practices.
Conclusions HF-exacerbating medication regimens are often continued or started following an HF hospitalization. These findings highlight an ongoing need to develop strategies to improve safe prescribing practices in this vulnerable population.
Supported by National Heart, Lung, and Blood Institute grant R01HL8077 and National Institute on Aging grant R03AG056446. Dr. Goyal has received research support from Amgen. Dr. Levitan has received research support from Amgen; is a member of the Amgen advisory board; and is a consultant for Novartis. Dr. Safford has received research support from Amgen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 30, 2019.
- Revision received August 2, 2019.
- Accepted August 6, 2019.
- 2019 American College of Cardiology Foundation
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