Background: Co-morbidity of both cardiac and non-cardiac conditions is common in the elderly with heart failure (HF) and can be associated with adverse clinical outcomes.
Objectives: The aims of this study were to examine the prevalence of comorbidity and potential treatment conflicts that may result in adverse clinical outcomes in a large cohort of elderly HF patients.
Methods: We conducted a cross-sectional study using administrative claims data (1 April to 31 July 2007) from the Department of Veterans’ Affairs, Australia, on all veterans aged ≥65 years with HF. Co-morbidities were defined using the pharmaceutical based co-morbidity index Rx-Risk-V. Potential treatment conflicts for patients with HF and co-morbid diseases were identified from Australian clinical guidelines or reference compendia and their prevalence in the data were determined.
Results: A total of 6730 patients were included in the study, with a median of 6 co-morbid conditions (interquartile range [IQR] 4–7) and 11 (IQR 8–15) unique medicines. Almost the entire HF cohort (97.8%) were identified as having at least one co-morbid condition that may cause a potential treatment conflict, with 55% having three or more. The conditions identified as being of greatest concern, based on their prevalence and potential for treatment conflict, were chronic airways disease, depression, chronic pain/inflammatory disease, glaucoma, diabetes mellitus and diseases treatable with corticosteroids.
Conclusions: Potential treatment conflicts are common in the highly co-morbid population of elderly patients with HF, and may influence the therapeutic management of not only HF but all conditions present.
Heart Failure Heart Failure Patient Adverse Clinical Outcome Prior Authorization Home Medicine Review
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This work was funded by the Australian Research Council/National Health and Medical Research Council of Australia from an Ageing Well Ageing Productively Program Grant and the work was independent of the funding source.
We thank the Australian Department of Veterans’ Affairs for providing the data used in this study. We also thank Professors Philip Ryan, Professor Adrian Esterman, Professor Mary Luszcz and Professor Robyn McDermott, the chief investigators who also collaborated with us on this project.
The authors declare they have no financial or any other kinds of personal conflicts associated with this manuscript.
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