In a recent blog, I talked about deprescribing and the benefits that accrue for patients and payers. As you know, one of the goals of deprescribing is reducing polypharmacy. I recently saw an interesting study on polypharmacy and heart failure that I think is illustrative of the numerous benefits that reducing polypharmacy offers patients and payers, so I thought I’d talk about it here.

The article, “Polypharmacy in Older Adults Hospitalized for Heart Failure,” appeared in the November 2020 edition of the American Heart Association “Circulation: Heart Failure” journal. It outlines a study that focused on a cohort of older adults who had been hospitalized for HF, drawn from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke).

As the article points out, polypharmacy is associated with adverse outcomes like falls, disability, and hospitalizations. This is especially relevant for older adults with HF, a population that is already vulnerable to the adverse effects of polypharmacy due to age-related alterations in pharmacokinetics and pharmacodynamics, changes in cardiovascular structure and function, and the coexistence of geriatric conditions like frailty and cognitive impairment.

The study cited in the article examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. The team collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. They counted the number of medications taken at hospital admission and discharge and classified each medication as either HF-related, non-HF cardiovascular-related, or non-cardiovascular-related.

The results were not surprising:

● Almost everyone took at least 5 medications (84% at admission and 95% at discharge) and over half took at least 10 medications (42% at admission and 55% at discharge);

● The prevalence of polypharmacy has increased over time, reflecting an urgent need to develop new strategies for managing high medication burden; and

● The majority of medications prescribed to older adults with HF were noncardiovascular in nature and may have limited benefit, supporting the need for processes that can optimize prescribing practices for this subset of medications

Notably, the study also concluded that the prevalence of polypharmacy increases sharply after a hospitalization for HF.

I agree with the study’s conclusion that there is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF. It is well-known that polypharmacy causes medication adherence problems and suboptimal medication behaviors in older patients, which can lead to potential complications, increased hospitalizations, and reduced quality of life.

We at CSS Health believe that simplifying complex medication management regimens builds adherence, manages costs, and improves patient lives.

To that end, we’ve recently rolled out a new polypharmacy program workflow for our signature MTMPath software, which will enable pharmacists to review patient charts, and develop tailored, targeted polypharmacy-related care plans for each patient. The new program workflow also spotlights drug interactions, makes care coordination and disease management recommendations, and flags inappropriate and duplicate therapies.

I am happy to discuss how you might incorporate the new CSS Health Polypharmacy Program Workflow into your medication management efforts and reduce polypharmacy—to the benefit of your company and your patients.

Best – Jim

Jim Notaro, RPh, PhD

Founder and Chief Clinical Officer