Medication regimen complexity in ambulatory older adults with heart failure

Michael R Cobretti,1 Robert L Page II,2 Sunny A Linnebur,2 Kimberly M Deininger,1 Amrut V Ambardekar,3 JoAnn Lindenfeld,4 Christina L Aquilante1 1Department of Pharmaceutical Sciences, 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, A...

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Autores principales:	Cobretti MR, Page RL 2nd, Linnebur SA, Deininger KM, Ambardekar AV, Lindenfeld J, Aquilante CL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	medication complexity heart failure elderly geriatric aged Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/157d31d80674490698935edeee686ed0
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spelling	oai:doaj.org-article:157d31d80674490698935edeee686ed02021-12-02T02:40:52ZMedication regimen complexity in ambulatory older adults with heart failure1178-1998https://doaj.org/article/157d31d80674490698935edeee686ed02017-04-01T00:00:00Zhttps://www.dovepress.com/medication-regimen-complexity-in-ambulatory-older-adults-with-heart-fa-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Michael R Cobretti,1 Robert L Page II,2 Sunny A Linnebur,2 Kimberly M Deininger,1 Amrut V Ambardekar,3 JoAnn Lindenfeld,4 Christina L Aquilante1 1Department of Pharmaceutical Sciences, 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 3Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, 4Advanced Heart Failure and Cardiac Transplant Program, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA Purpose: Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in “young-old” (60–74 years) versus “old-old” (75–89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM).Patients and methods: Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60–89 years with heart failure. Medications were categorized into three types – heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications – and scored using the pMRCI tool.Results: The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3–84) and total medication counts (13.3±4.8, range 2–30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications.Conclusion: Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population. Keywords: medication complexity, heart failure, elderly, geriatric, agedCobretti MRPage RL 2ndLinnebur SADeininger KMAmbardekar AVLindenfeld JAquilante CLDove Medical Pressarticlemedication complexityheart failureelderlygeriatricagedGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 679-686 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	medication complexity heart failure elderly geriatric aged Geriatrics RC952-954.6
spellingShingle	medication complexity heart failure elderly geriatric aged Geriatrics RC952-954.6 Cobretti MR Page RL 2nd Linnebur SA Deininger KM Ambardekar AV Lindenfeld J Aquilante CL Medication regimen complexity in ambulatory older adults with heart failure
description	Michael R Cobretti,1 Robert L Page II,2 Sunny A Linnebur,2 Kimberly M Deininger,1 Amrut V Ambardekar,3 JoAnn Lindenfeld,4 Christina L Aquilante1 1Department of Pharmaceutical Sciences, 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 3Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, 4Advanced Heart Failure and Cardiac Transplant Program, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA Purpose: Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in “young-old” (60–74 years) versus “old-old” (75–89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM).Patients and methods: Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60–89 years with heart failure. Medications were categorized into three types – heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications – and scored using the pMRCI tool.Results: The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3–84) and total medication counts (13.3±4.8, range 2–30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, P=0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, P=0.009; medication count 14.1±4.9 versus 12.2±4.5, P=0.008), which was largely driven by other prescription medications.Conclusion: Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population. Keywords: medication complexity, heart failure, elderly, geriatric, aged
format	article
author	Cobretti MR Page RL 2nd Linnebur SA Deininger KM Ambardekar AV Lindenfeld J Aquilante CL
author_facet	Cobretti MR Page RL 2nd Linnebur SA Deininger KM Ambardekar AV Lindenfeld J Aquilante CL
author_sort	Cobretti MR
title	Medication regimen complexity in ambulatory older adults with heart failure
title_short	Medication regimen complexity in ambulatory older adults with heart failure
title_full	Medication regimen complexity in ambulatory older adults with heart failure
title_fullStr	Medication regimen complexity in ambulatory older adults with heart failure
title_full_unstemmed	Medication regimen complexity in ambulatory older adults with heart failure
title_sort	medication regimen complexity in ambulatory older adults with heart failure
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/157d31d80674490698935edeee686ed0
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Medication regimen complexity in ambulatory older adults with heart failure

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