Nearly one in four adults prescribed medications that may worsen heart failure

In 2016, the American Heart Association published a list of medications that potentially cause or worsen heart failure. A new study looks at the prevalence with which such medications are actually prescribed in this high-risk population by analyzing insurance claims data from 2011 to 2015 for adults aged 18 to 64 years who had at least one hospitalization for heart failure, outpatient visits for heart failure, or a combination of both. Of the 40,966 patients included in the study, 9,954 (24%) filled a prescription for a potentially harmful drug (PHD), such as naproxen, the investigators reported in the May issue of the American Journal of Cardiology. 

A higher proportion of females than males were exposed to PHDs, and PHDs were also associated with a higher comorbidity burden, including hypertension, diabetes, atrial fibrillation, and obesity, the researchers noted. For example, among patients with diabetes, roughly 58% were exposed to a PHD versus 46% who were unexposed. Patients taking PHDs were also more likely to have diagnoses of osteoarthritis and depression.

NSAIDs like diclofenac and ibuprofen were the most frequently prescribed class of PHD, accounting for 44% of the 15,237 PHD prescriptions dispensed. Potentially harmful antihypertensives such as diltiazem and potentially harmful diabetes medications such as pioglitazone accounted for 15.7% and 15.3% of prescription fills, respectively. Neurological/psychiatric medications, including citalopram, similarly accounted for 15.5% of prescriptions. 

Patients who received a prescription for a PHD were also likely to have it happen more than once. For NSAIDs, the researchers noted, each patient received 4.5 prescriptions from this PHD class. Still, given the OTC availability of NSAIDs, the seeming high prevalence of their use may be an underestimation, the researchers wrote.

In other findings, use of ACE inhibitors and ARBs, beta-blockers, aldosterone antagonists, and loop diuretics was each significantly more common among patients exposed to PHDs than among their nonexposed peers, the researchers reported. Patients with polypharmacy (>five medications) were 69% more likely to receive a PHD than those on fewer medications. Yet, among patients taking multiple medications, those with PHDs more commonly received cardiologist care than those unexposed to PHDs, the report indicated.

Patients who received guideline-directed therapy were 10% less likely to receive a PHD, however, the researchers noted. 

The findings do not appear surprising to Angela Cheng, PharmD, clinical pharmacy manager and cardiology specialist at Montefiore Health System in New York City. “At the heart failure clinic, we sometimes have to discontinue certain medications because they can have a negative effect on heart failure,” said Cheng, who was not involved in the study. She suspects the high number of PHDs may be due to various factors, including lack of patient follow-up and miscommunication during physician visits.

“If you don’t ask, the patient may not tell you,” said Cheng, about patients taking OTC NSAIDs. They may not think it is important to mention, she explained, and “doctors may not have time to ask.”

For the full article, please visit www.pharmacytoday.org for the July 2019 issue of Pharmacy Today.