Dangerous Medications Prescribed to Nearly 25% of Patients with Heart Failure With Reduced Ejection Fraction (Video)
Roughly 24% of patients with HF with reduced ejection fraction were prescribed a medication that could potentially lead to or worsen HF as defined by current guidelines, according to a study published in The American Journal of Cardiology.
Paulino A. Alvarez, MD, a cardiologist and assistant professor of internal medicine at the University of Iowa in Iowa City, and colleagues analyzed data from 40,966 patients (75% aged 51 to 64 years; 64% men) with HFrEF.
Pharmacy claims for potentially harmful drugs were assessed either from retail pharmacies or mail specialty pharmacies. Potentially harmful drugs were defined as oral medications that could either induce or precipitate HF based on a previous American Heart Association scientific statement and included diabetes medications, non-steroidal anti-inflammatory agents, antihypertensives, pulmonary medications, anti-arrhythmic medications and psychiatric and neurological medications.
Of the patients in the study, 24.4% were prescribed potentially harmful drugs. For those who had at least one potentially harmful drug prescribed, the most frequent medications included NSAIDs (67.4%), antihypertensives (24%), diabetes medications (23.3%), neurological and psychiatric medications (21%) and anti-arrhythmic medications (12.6%).
Elevated risk for potentially harmful drug prescriptions was observed in women (OR = 1.16; 95% CI, 1.1-1.22) and in patients with comorbidities including hypertension (OR = 1.36; 95% CI, 1.25-1.47), osteoarthritis (OR = 1.7; 95% CI, 1.61-1.79), atrial fibrillation (OR = 1.23; 95% CI, 1.17-1.29), diabetes (OR = 1.52; 95% CI, 1.44-1.59) and neurological and/or psychiatric disorders (OR = 1.42; 95% CI, 1.35-1.5).
“Adherence to the ACC/AHA guidelines and careful review of medication lists by prescribing physicians and especially cardiologists is crucial,” Alvarez and colleagues wrote. “Furthermore, monitoring strategies should be incorporated in electronic medical records and prescription systems to detect and prevent, if possible, prescription of [potential harmful drugs].” – by Darlene Dobkowski
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