Prescribing Patterns of HF-Exacerbating Medications

Study Questions:

What is the current practice of medications prescribed at the time of admission and at hospital discharge exacerbating heart failure (HF)?

Methods:

A total of 588 patients ≥65 years of age who were hospitalized for HF from 2003-2014 were studied from the REGARDS (Reasons for Geographic and Racial Difference in Stroke) study. HF-exacerbating medications were defined by the 2016 American Heart Association Scientific Statement as major exacerbating agents that can have potential life-threatening effects leading to hospitalization or emergency room visit. Variables studied included cardiac and comorbid conditions that exacerbate HF, left ventricular ejection fraction (LVEF), length of stay, cardiology consultation, intensive care unit stay, and hospitalization year. Hospital size, academic status, and hospital rating were also evaluated. A multivariable logistic regression analysis was used to help determine factors that lead to prescribing HF-exacerbating medications.

Results:

The median age of 588 patients was 76 years (interquartile range [IQR], 72-83) and included 44% women and 34% blacks. The median number of medications at hospital admission was 9 (IQR, 6-12), and at hospital discharge was 10 (IQR, 8-13). The prevalence of HF-exacerbating medications at hospital admission was 41% and at discharge 36%. Patients with several comorbid conditions (chronic obstructive pulmonary disease/asthma, diabetes, and mood disorder) were more likely to be prescribed HF-exacerbating medications either on admission or at time of discharge. The most common HF-exacerbating medications prescribed on hospital admission were albuterol, metformin, nonsteroidal anti-inflammatory drugs, and diltiazem. The most common at time of discharge were albuterol, metformin, and diltiazem. Patterns were more prevalent for patients with HF with preserved EF at both admission and discharge. In multivariable logistic regression analysis, diabetes (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.18-2.75) and small hospital size (OR, 1.93; 95% CI, 1.18-3.16) were most strongly associated with prescribing HF-exacerbating medications.

Conclusions:

At time of admission and during hospitalization and discharge, HF-exacerbating medications are being prescribed for patients being treated for any type of HF.

Perspective:

It is crucial at time of discharge to develop a system for patient medication reconciliation in order to ensure the safety of medications prescribed. More importantly, when patients are hospitalized for HF, the necessity of ensuring that HF-exacerbating medications are not continued can help facilitate an overall safe discharge.

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Albuterol, Anti-Inflammatory Agents, Non-Steroidal, Asthma, Comorbidity, Diabetes Mellitus, Diltiazem, Emergency Service, Hospital, Geriatrics, Heart Failure, Length of Stay, Medication Reconciliation, Metformin, Mood Disorders, Patient Discharge, Pulmonary Disease, Chronic Obstructive, Stroke, Stroke Volume


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