The problem of polypharmacy in heart failure

Abstract

Improvements in the medical therapy for chronic heart failure have led to a dramatic decrease in the morbidity and mortality of patients with heart failure over the past two decades. This improvement has been gained at the expense of an increasing number of potent drugs that heart failure patients have to take chronically. Because heart failure forms the end-stage of different cardiovascular diseases and their predisposing risk factors, patients need drug treatment not only for heart failure itself but also for related conditions. Even more, because most heart failure patients are elderly, a number of unrelated, noncardiovascular diseases become apparent, which further increase the number of pharmaceutical substances with which heart failure patients are treated. The resulting polypharmacy leads to problems including economic burden, patient compliance, and most importantly, partly unpredictable drug interactions. This article reviews the existing data concerning some of these problems, to provide an aid for choosing the appropriate drugs in heart failure patients and minimizing the patient's risk.

Predicting the Risk of Cardiovascular Comorbidities in Adult Cancer Survivors

“…The use of cardiovascular medications in cancer patients who are undergoing active anticancer therapies (for example, hormonal treatment) can also lead to polypharmacy, which can increase the risk of nonadherence, the cost of treatment, and the potential for drug interactions 6,7 .…”

Heart Failure and Adverse Drug Reactions Among Hospitalized Older Adults

“…In addition, conditions frequently associated with HF, such as coronary artery disease or depression, may require further pharmacological treatment 16 . Simultaneous use of these medications clearly increases the risk of drug–drug interaction and iatrogenic illness 17 …”

Polypharmacy in heart failure: A growing challenge

“…Each drug developed targets a different pathophysiological mechanism associated with the heart failure syndrome. This together with the ethical constraints in using placebo-controlled trials or withdrawing beneficial medications from trial participants, has led to the evidence that supports pharmacotherapy in heart failure being developed from data largely generated in 'add on' trials (Flesch, Erdmann 2006).…”

“…Transferring this evidence into practice can therefore be difficult and whilst medications are generally beneficial they still have the potential to do harm. The combination of drugs used in heart failure carries risks of renal deterioration, hyperkalaemia and hypotension (Flesch, Erdmann 2006) and these can be exacerbated in the elderly (Leibundgut et al, 2007). The three RAA antagonists (ACEi, ARB and AI) used in heart failure can each cause reduced renal function and increased potassium levels due to their potassium sparing properties.…”