Elsevier

Heart Failure Clinics

Volume 10, Issue 2, April 2014, Pages 367-372
Heart Failure Clinics

Comorbidities and Polypharmacy

https://doi.org/10.1016/j.hfc.2013.12.001Get rights and content

Section snippets

Key points

  • Heart failure (HF) is predominantly a disease that affects the elderly population, a cohort in which comorbidities are common.

  • The majority of comorbidities and the degree of their severity have prognostic implications in HF.

  • Polypharmacy in HF is common, has increased throughout the past 2 decades, and may pose a risk for adverse drug interactions (ADRs), accidental overdosing, or medication nonadherence.

  • Polypharmacy, in particular in the elderly, is rarely assessed in traditional clinical

Common comorbidities and treatment implications in HF

HF can originate from multiple inherited or acquired cardiac or noncardiac diseases and usually converges into a clinical syndrome characterized by typical HF symptoms and evidence of reduced cardiac function. Given this vastly complex and heterogenous spectrum of HF pathomechanisms, it is not surprising that numerous other conditions can coexist in HF. Some of these comorbidities may precede and even induce HF; others may occur independently, albeit with temporal overlap. Yet other conditions,

Polypharmacy in HF—scope of the problem

HF commands the use of several drugs, including angiotensin-converting enzyme inhibitors, β-blockers, and mineralocorticoid receptor antagonists.12, 29 There is a clear trend for an increasing number of drugs used in patients with HF. Recent data in a community-based HF population indicate that the average number of prescription drugs managed by HF patients increased from 4.1 to 6.4 over the past 2 decades, reflecting a significant increase in the number of comorbidities per patient (Fig. 1).30

Significance of polypharmacy for HF pharmacotherapy

Interactions between specific drugs to treat HF and those to treat comorbidities are common and greatly augment the complexity of HF management.

Medical treatment of HF with comorbidities often faces the dilemma of mutually exclusive drugs, that is, drugs that improve one condition and deteriorate another or vice versa.

As an example, in HF and comorbid respiratory disease, β-blockers represent a cornerstone of contemporary HF pharmacotherapy but may have an adverse impact on pulmonary function.

Managing polypharmacy in HF patients with comorbidities

Some fundamental principles in pharmacotherapy may inform treatment decisions in elderly HF patients with extensive comorbidities. In general, possible negative consequences of medical and nonpharmacologic interventions need to be considered. For instance, if renal function is impaired, angiography and other contrast-enhanced diagnostic procedures should be performed only if clear clinical benefit is expected. Drugs with known risk of interactions need to be carefully up-titrated, and

Summary and concluding remarks

In patients with HF, the prevalence of comorbidities, the extent of polypharmacy, and the associated additional morbidity and mortality have increased significantly over recent years, although some uncertainty remains on the true prevalence of comorbidities as a result of varying disagreement between self-reported and clinically diagnosed comorbidities. HF patients with comorbidities more often are elderly, have more comorbidities, and exhibit increased risk of ADRs. Polypharmacy is becoming a

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