Polypharmacy on first admission to hospital for people with heart failure: baseline findings from the PULSE cohort.

Abstract

Aim: To define and characterise polypharmacy in people with heart failure.

Methods: The PULSE dataset is a bespoke single centre, retrospective, longitudinal, observational cohort database of patients hospitalised for heart failure, capturing data from the first heart failure admission through to death or end of data collection, including all subsequent admissions. First admission with heart failure was used to define baseline polypharmacy.

Results: There were 660 patients included in the dataset, 55.6% male, mean age 76.1 (± SD12.3). Median number of medications on admission was 9 and on discharge 10 (25th-75th centile 7-12). Polypharmacy prevalence was 87.3% on admission, increasing at discharge to 95.1% (p<0.001). Mean medication complexity index score increased from 28.5 (±SD 14.9) at admission to 31.8 (± 14.1) at discharge; (p<0.001). Number of medications on admission increased with increasing age (p<0.001), higher Charlson Comorbidity Index (p<0.001), numerically more comorbidities (p<0.001), higher clinical frailty scale (p<0.001), longer length of stay (p=0.03), worse New York Heart Association class of symptoms (p=0.04) and a diagnosis of heart failure with preserved ejection fraction compared to heart failure with reduced ejection fraction (p=0.002). Cardiovascular medications contributed 50% of medications. Prescribing of heart failure medications reduced with increased polypharmacy.

Conclusion: Polypharmacy is common on first admission to hospital for people with heart failure. More medications at admission is associated with increasing age, co-morbidity, and frailty. People with polypharmacy are more likely to have a heart failure with preserved ejection fraction diagnosis, have worse symptoms and a longer hospital stay.