Akademik Veri Yönetim Sistemi
50th ESCP Symposium on Clinical Pharmacy, Polypharmacy and ageing - highly individualized, interprofessional, person-centered care, Praha, Çek Cumhuriyeti, 19 - 21 Ekim 2022, cilt.44, ss.1535
Importance and necessity of pharmacists in the management of polypharmacy in heart failure patients with comorbidities
Background and Objective: The progressive use of many medications and a complicated therapy protocol is frequent in heart failure (HF) and is encouraged by international guidelines. Because HF is an ailment frequently seen in the elderly, patients often have multiple comorbidities that require additional specific therapy, resulting in the simultaneous use of multiple drugs (1). Polypharmacy, described as the continuous use of five or more drugs, is an underappreciated issue in the treatment of heart failure patients (2). Polypharmacy has a major effect on HF treatment because it frequently leads to incorrect drug prescribing, poor adherence to pharmacological treatments, drug-drug interactions, and side effects (3). As the part of the medical crew the pharmacist can take responsibility to determine and help solution of drug-related problems. The aim of this study was to determine the frequency of comorbidity in HF patients, the rate of exposure to polypharmacy and the frequency of drug interactions.
Method: A prospective pilot observational research was conducted on HF patients in a cardiology department of a hospital between 22–30 September 2021. Patients’ demographic data and other relevant informations were collected via face-to-face.
Main outcome measures: Sociodemographic characteristics of heart failure patients. Comorbidities, regularly used drugs, drug-drug interactions, commonly seen side effects.
Results: 39 heart failure patients with a mean age of 78.87 ± 2.34 were participated in the study. 22 (56.4%) of the participants were male. Patients in the study had heart failure for an average of 6.97 ± 1.39 years. 37 (94.9%) of the patients had comorbidities and 28 (71.8%) of the patients had at least 2 comorbidities. Hypertension (30%) was the most commonly seen comorbidity and the average comorbidity number of the patients in the study was 2.5. 30 (77%) of the patients were using 5 or more drugs in a day. 207 (74.7%) drugdrug interactions were detected among a total of 277 drugs used by patients. 197 (95.2%) of drug interactions were in category C, others were in category D and X. Furosemid 50 (18%) and metformin 34 (12.3%) were the drugs with the most drug interactions. 34 (87.2%) of the patients complaint about side effects and nausea 16 (47%) was the most commonly seen side effect.
Conclusion: It was detected that 30 (76.9%) of the patients suffer from polypharmacy and there was a significant rate of (74.7%) drug-drug interactions. Polypharmacy which is the most common cause of drugdrug interactions, leads to greater drug expenses, more adverse events, and nonadherence to medicine. On the other hand polypharmacy is inevitable in some situations such as the presence of comorbidities. It is essential that pharmacists—who are the pharmaceutical specialiststake responsibility especially when polypharmacy is unavoidable and guide physicians in drug selection. Thereby polypharmacy related drugdrug interactions and other problems can be reduced.
Disclosure of Interest: None Declared.
References: (1) Braunstein JB, Anderson GF, Gerstenblith G, et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42(7):1226–33.
(2) Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867–78.
(3) Hilmer SN, Gnjidic D. The effects of polypharmacy in older
adults. Clin Pharmacol Ther. 2009;85(1):86–8.