Pharmacological treatment in patients with heart failure: patients knowledge and occurrence of polypharmacy, alternative medicine and immunizations

Abstract

Aims: To evaluate in patients with heart failure (HF) due to systolic dysfunction the occurrence of polypharmacy, alternative medicine, immunization against influenza, and patients' knowledge about their medication. Methods and results: Sixty-five patients, 49 men, mean age 60.5"12.0 years answered a confidential questionnaire during 2002. Polypharmacy was frequent, 48 (74%) were taking six or more pills per day and 18 (28%) 11 or more. Fifteen patients (23%) used over-the-counter analgesics. Eight patients (12%) used alternative medicine wfive women (31%) vs. three men (6%), Ps0.02x. Forty-four patients (68%) received immunization against influenza (18 patients -65 years (54%) vs. 25 patients G65 years (79%), Ps0.03). Half the patients knew that beta-blockers and vasodilators decreased blood pressure, 31 patients receiving diuretics (88%) knew that this drugs help to eliminate liquids, 12 patients (38%) recognized this effect with low dose spironolactone and 23% or less with other drugs. Only 12 patients (42%) treated with acenocoumarol and 13 of those treated with aspirin (32%) recognized the action of these drugs. Conclusion: Patients with HF and systolic dysfunction have a poor knowledge about the medication they receive. Polypharmacy, over-the-counter, homeopathic and alternative medicine use is frequent whereas the rate of immunization against influenza is low.

State of the Science

“…It is common for patients with HF and comorbidities to be taking 9 to 12 pills per day and to lack even a simple understanding of the medications taken. 102,117,118 Surprisingly, in prior reports, up to 12% of patients taking multiple medications did not understand the purpose or effect of the diuretic they were taking, and 50% to 77% did not understand the purpose or effects of their other medications. 102,119 Furthermore, adherence to prescribed medications is lower in patients with HF who have multiple comorbidities.…”

“…102,117,118 Surprisingly, in prior reports, up to 12% of patients taking multiple medications did not understand the purpose or effect of the diuretic they were taking, and 50% to 77% did not understand the purpose or effects of their other medications. 102,119 Furthermore, adherence to prescribed medications is lower in patients with HF who have multiple comorbidities. 14,102,[117][118][119][120] This is not to say, however, that patients should be prescribed fewer medications to increase adherence.…”

“…54 Thus, it is not surprising that in a European study, only 68% of community-dwelling HF patients received an influenza immunization. 102 In another study, factors such as age, respiratory problems, diabetes mellitus, and HF were associated with greater rates of immunization, whereas low education, smoking, and poor medication adherence were negatively associated with influenza immunization. 103 These results suggest that self-care maintenance behaviors (eg, diet, exercise, and medication taking) may cluster, but further research is needed before this can be said definitively.…”

“…102,119 Furthermore, adherence to prescribed medications is lower in patients with HF who have multiple comorbidities. 14,102,[117][118][119][120] This is not to say, however, that patients should be prescribed fewer medications to increase adherence. In fact, medication adherence has been found to be higher in patients taking more medications than in those taking fewer medications.…”

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

“…Concurrent use of nitrates, alpha-blockers, BBs, ACEIs, diuretics, sildenafil, and CCBs increases the risk of hypotension. Concurrent use of amiodarone, BBs, digoxin, verapamil, diltiazem, sotalol, and propafenone is associated with the risk of bradycardia (107,108).…”