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Appropriateness of Medications Prescribed to Elderly Patients with Advanced Heart Failure and Limited Life Expectancy Who Died During Hospitalization

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Abstract

Background and objectives

Drug therapy in patients with advanced heart failure and limited life expectancy may be of no benefit or even inappropriate. The aim of this study was to analyze the appropriateness of medication prescribed to patients with advanced heart failure and limited life expectancy, considering as such an expected median survival of less than 6 months.

Methods

We retrospectively reviewed data on all patients with advanced heart failure who met criteria for limited life expectancy and who died in the geriatric ward of a tertiary hospital over a four-and-a-half-year period. We analyzed treatments prescribed before admission, especially drugs used for prophylaxis or to prolong life.

Results

A total of 72 patients were included. The mean age was 85.4 years, and 52.3 % were women. Mean Charlson index was 3.2. Prophylactic medications taken by patients at admission were antiplatelets in 40 patients (55.6 %), oral anticoagulants in 17 (23.6 %), statins in 14 (19.4 %), and osteoporosis medication in nine (12.5 %). Medications taken to prolong survival were angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists in 29 patients (40.3 %). Other medications were iron supplements in 19 patients (26.4 %), vitamins in two (2.8 %), and acetylcholinesterase inhibitors in two (2.8 %).

Conclusions

Our results show that patients with advanced heart failure and limited life expectancy were receiving an excessive number of prophylactic medications, drugs to prolong life, and other inappropriate treatments. These findings emphasize the need to review drug therapy in an individualized manner in elderly patients with advanced stages of heart disease and a poor prognosis.

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References

  1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 128:e240–7; originally published online June 5, doi:10.1161/CIR.0b013e31829e8776.

  2. Salpeter SR, Luo EJ, Malter DS, et al. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med. 2012; 125 (5):512.e1–16.

  3. Cruz-Jentoft A, Boland B, Rexach L. Drug therapy optimization at the end of life. Drugs Aging. 2012;29(6):511–21.

    Article  PubMed  Google Scholar 

  4. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  5. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA. 1963;185:914–9.

    Article  CAS  PubMed  Google Scholar 

  6. Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity and guidelines. J Clin Oncol. 1984;2(3):187–93.

    CAS  PubMed  Google Scholar 

  7. McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.

    Article  CAS  PubMed  Google Scholar 

  8. Delgado E, Muñoz M, Montero B, et al. Prescripción inapropiada de medicamentos en los pacientes mayores: los criterios STOPP/START. Rev Esp Geriatr Gerontol. 2009;44(5):273–9.

    Article  Google Scholar 

  9. Mannucci PM. Thromboprophylaxis in the oldest old with atrial fibrillation: between Scylla and Charybdis. Eur J Intern Med. 2013;24:285–7.

    Article  PubMed  Google Scholar 

  10. O’Brien CP. Withdrawing medication. Managing medical comorbidities near the end of life. Can Fam Phys. 2011; 57:304–7.

  11. McMurray JJV, Adamopoulos S, Anker SD, et al. Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC. Eur Heart J. 2012;33:1787–847.

    Article  PubMed  Google Scholar 

  12. O’Mahony D, O’Connor M. Pharmacotherapy at the end of life. Age Ageing. 2011;40:419–22.

    Article  PubMed  Google Scholar 

  13. Captopril Multicenter Research Group. A placebo-controlled trial of captopril in refractory chronic congestive heart failure. J Am Coll Cardiol. 1983;2:755–63.

    Article  Google Scholar 

  14. Holmes HM, Hayley DC, Alexander GC, et al. Reconsidering medications appropriateness for patients late in life. Arch Intern Med. 2006;166:605–9.

    Article  PubMed  Google Scholar 

  15. Binaray C, Califf RM, Hasselblad V, et al. ESCAPE investigators and ESCAPE study coordinators. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness: the ESCAPE trial. JAMA. 2005;294:1625–33.

    Article  Google Scholar 

  16. Goodlin SJ. Palliative care in congestive heart failure. J Am Coll Cardiol. 2009;54:386–96.

    Article  PubMed  Google Scholar 

  17. Lee SJ, Leipzig RM, Walter LC. Incorporating lag time to benefit into prevention decisions for older adults. JAMA. 2013;310(24):2609–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Levy WC, Mozaffarian D, Linker DT, et al. The Seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113:1424–33.

    Article  PubMed  Google Scholar 

  19. Aaronson KD, Schwartz JS, Chen TM, et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation. 1997;95:2660–7.

    Article  CAS  PubMed  Google Scholar 

  20. Fonarow GC, Adams KF Jr, Abraham WT, ADHERE Scientific Advisory Committee, Study Group, and Investigators, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293:572–80.

    Article  CAS  PubMed  Google Scholar 

  21. Lee DS, Austin PC, Rouleau JL, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581–7.

    Article  CAS  PubMed  Google Scholar 

  22. O’Connor CM, Hasselblad V, Mehta RH, et al. Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score. J Am Coll Cardiol. 2010;55:872–8.

    Article  PubMed  Google Scholar 

  23. Allen L, Co-Chair MHS, et al. Decision making in advanced heart failure. Circulation. 2012;125:1928–52.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Gómez-Batiste X, Martinez-Muñoz M, Blay C, et al. Proyecto NECPAL CCOMS-ICO©: Instrumento para la identificación de personas en situación de enfermedad crónica avanzada y necesidad de atención paliativa en servicios de salud y sociales. Centro colaborador de la OMS para programas públicos de curas paliativas. Institut Català d’Oncologia. Available at http://www.iconcologia.net.

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Acknowledgments

We thank Carolyn Newey for help with the English in this paper. No sources of funding were used to assist in carrying out this study or in the preparation of this article. The authors have no potential conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Geriatric Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    Montserrat Barceló, Olga Torres & Domingo Ruiz

  2. Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    Jordi Casademont

Authors
  1. Montserrat Barceló
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  2. Olga Torres
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  3. Domingo Ruiz
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  4. Jordi Casademont
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Correspondence to Montserrat Barceló.

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Barceló, M., Torres, O., Ruiz, D. et al. Appropriateness of Medications Prescribed to Elderly Patients with Advanced Heart Failure and Limited Life Expectancy Who Died During Hospitalization. Drugs Aging 31, 541–546 (2014). https://doi.org/10.1007/s40266-014-0183-3

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  • DOI: https://doi.org/10.1007/s40266-014-0183-3

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