Trends in Comorbidity, Disability, and Polypharmacy in Heart Failure

Abstract

BACKGROUND Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population. METHODS Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988–1994, 1999–2002, 2003–2008). RESULTS We identified 1395 participants with self-reported heart failure (n = 581 in 1988–1994, n = 280 in 1999–2002, n = 534 in 2003–2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988–1994 to 22.4% in 2003–2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years. CONCLUSION The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.

The Changing Landscape – Palliative Care in the Heart Failure Patient Population

“…As stated at the beginning of this chapter, current patients with HF are older, have more comorbidities, and take more medications than in the past (Wong et al 2011). During the time period of 2003 to 2008, patients with HF were taking an average of 6.4 prescription cardiac medications, with 10% of these patients taking more than an average of 11 cardiac medications (Wong et al 2011).…”

“…Current patients with HF are older, have more co-morbidities, and take more medications than in the past (Wong et al 2011). This trend is likely to continue, as the proportion of elderly individuals is projected to increase for some time (Foot et al 2000).…”

Chronic heart failure

“…Over half of patients with heart failure reported five or more chronic conditions in a US community-based study. 8 While cardiac diseases including hypertension, hypercholesterolaemia, ischaemic heart disease and myocardial infarction are the more common comorbidities, chronic obstructive pulmonary disorder, diabetes, depression and renal failure are most strongly associated with adverse outcomes. Renal dysfunction with heart failure, termed cardiorenal syndrome, has a particularly poor prognosis.…”

Understanding Hospitalization in Patients with Heart Failure

“…[16][17][18][19] The relevance of the "rehospitalization" topic in the last decade involves two important points: first, the perception that reducing these rates would be a window of opportunity to decrease the waste of resources in the health system and, second, that the hospitalization causes additional damage to the heart and other organs. Hospitals in the United States with high rates of rehospitalization have started to be penalized, which led to a search for evidence-based strategies capable of improving the performance of these instituitions.…”