Evidence suggests that while significant focus has been placed on ensuring that patients with heart failure (HF) are prescribed medications like beta-blockers and other neurohormonal antagonists that have been shown to improve outcomes, little attention has been paid to discontinuing medications that can worsen HF. For a study published in JACC: Heart Failure, Parag Goyal, MD, MSc, FACC, and colleagues sought to better understand the prevalence of harmful medication use in the setting of HF-related hospitalization.
The study team examined a cohort of older adults hospitalized for HF from 380 unique hospitals across the United States, identifying medications taken at admission and prescribed at discharge, cross-referencing these lists with the 2016 American Heart Association (AHA) Scientific Statement on 70 medications that can exacerbate HF, and analyzing the data to determine predictors for harmful prescribing practice.
“Medications that can worsen HF are commonly used in older adults with HF,” says Dr. Goyal. Indeed, the study showed that nearly half of patients hospitalized for HF were on HF-exacerbating medications at the time of hospital admission, with 18% experiencing a decrease in the number of these medications by hospital discharge, 19% remaining on the same number, and 12% experiencing an increase. Upon multivariable logistic regression analysis, diabetes (odds ratio [OR], 1.80) and small hospital size (OR, 1.93) were the strongest, independently associated determinants of harmful prescribing practices.
“Despite possibly contributing to the hospitalization, these potentially harmful medications are often continued even upon hospital discharge,” adds Dr. Goyal. “When older adults with HF are hospitalized, it is critical to perform a thorough review of all medications and to consider eliminating medications that could possibly worsen HF. To achieve this, it is important to increase awareness about how common potentially harmful medication use is, and for physicians to become increasingly familiar with which medications may be harmful. It is equally important for clinicians to also incorporate their own judgement and patient preferences when deciding whether to discontinue a medication that may be harmful in HF, since many of the agents listed on the 2016 AHA Scientific Statement may be first-line treatments for common HF comorbidities, like diabetes and COPD.”