Background While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF. Methods We studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003–2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF. Results The prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy. Conclusion Hyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
OBJECTIVES To determine whether the number of medications taken by adults with heart failure (HF) and impairment in activities of daily living (ADL)—a subpopulation in whom the risks of a high medication burden may outweigh the benefits—differs from the number taken by those without impairment in ADLs. DESIGN Cross‐sectional. SETTING National Health and Nutrition Examination Survey (NHANES; 2003–2014), a cross‐sectional survey that produces national estimates of adults in the United States. PARTICIPANTS Adults aged 50 and older (mean 70) with self‐reported HF (N= 947; representing 4.6 million adults with HF in the United States. MEASURMENTS We assessed ADL impairment and medication count based on self‐report. ADL impairment was defined as having difficulty with or being unable to dress, feed oneself, or get in and out of bed. To determine the independent association between ADL impairment and medication count, we performed sequential Poisson multivariable regression analyses. All analyses were cross‐sectional in nature and accounted for the complex survey design of NHANES. RESULTS Mean medication count was 7.2, and 74% of participants were taking 5 or more medications (polypharmacy). In a multivariable model, ADL impairment was not independently associated with medication count. These findings were similar for those with 3 or more hospitalizations in the prior year, declining health status, and cognitive impairment. CONCLUSION After adjusting for confounders including comorbidity, we found that adults with HF and ADL impairment take as many medications as those without ADL impairment. This suggests that providers may not sufficiently consider functional impairment when prescribing medications to adults with HF and thus may unnecessarily expose individuals to risk of adverse outcomes. J Am Geriatr Soc 67:284–291, 2019.
BackgroundPreviously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all‐cause mortality in REGARDS participants with existing CHD.Methods and ResultsWe included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events—definite or probable MI or acute CHD death—and all‐cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant‐based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow‐up, there were 581 recurrent CHD events and 1098 deaths. In multivariable‐adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62–0.98; PT rend=0.036). The Southern dietary pattern was adversely associated with the hazard of all‐cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28–1.91; P Trend<0.001). The Mediterranean diet score was inversely associated with the hazard of all‐cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67–0.95; PT rend=0.014).ConclusionsThe Southern dietary pattern was associated with a greater hazard of all‐cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all‐cause mortality.
Background: Cognitive impairment (CI) is estimated to be present in 25%−80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study. Methods: REGARDS is a longitudinal cohort study of adults ≥45 years of age recruited from 2003-2007. Incident HF was expert-adjudicated. Cognitive function was assessed with the Six-Item-Screener. The prevalence of CI among those with incident HF was compared to the prevalence of CI among an age, sex, and race-matched cohort without HF. Results:The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female gender, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [11.7-18.6%]) was similar to the non-HF matched cohort (13.4% [11.6% -15.4%], p<0.43). Conclusion:14.9% of adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients, and ways to mitigate it in the context of HF management, are warranted.
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