Polypharmacy and Distinctive Demographics of Congestive Heart Failure

Polypharmacy and Distinctive Demographics of Congestive Heart Failure Patients Seenu Abraham 1, Peter Vayalil 1, Sagar Patel 1, Tim Quinn 1, Jeffrey Hackman 1, 2, Lawrence Dall 1, 2 1 UMKC School of Medicine, 2 Truman Medical Center INTRODUCTION • • 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. Average 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) • • • 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) • • • METHODS • CONCLUSION/FUTURE DIRECTION RESULTS 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 • SUMMARY • • 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. • 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 1. 2. 3. 4. 5. 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_finalreport 1110. 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.