Abstract
Background
The unintentional prescribing of medications harmful for patients with heart failure (HF) remains an ongoing problem. The American Heart Association published a scientific statement detailing a list of medications that may worsen or exacerbate a patient’s HF. The use of potentially harmful medications has not been studied in Medicare patients with HF.
Objective
The aim of this study was to assess the prevalence of prescribing these harmful medications in a Medicare-enrolled medication therapy management (MTM)-eligible population with HF and to identify the characteristics associated with this potentially harmful prescribing.
Methods
This cross-sectional analysis involved utilization of a national MTM provider’s database for the 2018 calendar year. Eligible patients were included if they were Medicare enrolled, MTM eligible, and with International Classification of Disease 9/10 codes for HF. Counts and percentages were used to describe the prevalence of potentially harmful medication use and prescribing, by physician specialty. Exploratory logistic regression assessed the relationship between unique patient characteristics and potentially harmful prescribing.
Results
A total of 13,250 patients were included, of whom 7017 (53%) were prescribed at least one potentially harmful medication. The most frequently prescribed medications in this cohort were nonsteroidal anti-inflammatory drugs (NSAIDs; 3357, 25%), dipeptidyl peptidase-4 (DPP4) inhibitors (3117, 24%), and non-dihydropyridine calcium channel blockers (CCBs; 936, 7%). A logistic regression found female sex, increasing polypharmacy, years qualified for MTM, higher poverty level, number of prescribers, and number of pharmacies were associated with potentially harmful medication prescribing. Of 17,548 potentially harmful medications encountered in a 4-month span, 9433 (54%) were prescribed by physician primary care providers.
Conclusions
Over one-half of patients with HF were prescribed one or more potentially harmful medication(s). Automated monitoring of prescription claims and implementation of alerts in electronic health records in primary care is warranted to reduce potentially harmful medication use among Medicare MTM-eligible patients.
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Acknowledgements
The authors appreciate the editorial contributions of Ann M. Taylor, MPH, MCHES, and would also like to acknowledge the efforts of the IT group at SinfoníaRx in preparing the de-identified data set. Results from this investigation were presented in part at the American College of Clinical Pharmacy Annual Meeting in New York, NY, USA, on 26 October 2019.
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Milap C. Nahata is supported in part by The Avatar Foundation.
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Armando Silva Almodóvar and Milap C. Nahata declare no conflicts of interest that may be relevant to this report.
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Silva Almodóvar, A., Nahata, M.C. Potentially Harmful Medication Use Among Medicare Patients with Heart Failure. Am J Cardiovasc Drugs 20, 603–610 (2020). https://doi.org/10.1007/s40256-020-00396-z
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DOI: https://doi.org/10.1007/s40256-020-00396-z