(082) Prevalence And Patterns of Drug-Related Problems Associated with Polypharmacy in Elderly Patients with Heart Failure: A Prospective Interventional Study

Background: Polypharmacy, defined as the concurrent use of 5 or more medications, is highly prevalent among elderly patients with heart failure (HF). It predisposes to increased risk of drug-related problems (DRPs) like adverse drug reactions, drug interactions and medication noncompliance. However, little data exists on the pattern of DRPs associated specifically with polypharmacy in Indian elderly HF patients.

Objectives: This study aimed to assess the incidence and types of DRPs linked to polypharmacy in elderly patients diagnosed with HF

Methods: A prospective cohort study was conducted in the Department of Geriatrics and Cardiology of a tertiary care hospital in Southern India over a period of six months. All elderly patients (aged ≥ 60 years) of either sex, who were diagnosed with HF at any stage, were enrolled in the study. All patients were reviewed and followed till discharge for any DRP occurrence. Predictors associated with DRPs were assessed using odds ratios (ORs) at 95% confidence intervals.

Results: A total of 130 patients with HF were enrolled in this study, 66.15% were male and the mean age was 74 years. Over 50% of the patients were diagnosed with heart failure with reduced ejection fraction (HFrEF). A total of 394 DRPs were identified, [62 (47.69%)] of the patients received polypharmacy (≥5 medicines), and the remaining [68 (52.31%)] received hyperpolypharmacy (≥10 medicines). The most common DRPs observed were drug-drug interactions, followed by alternative dosage forms, and adverse drug reactions (ADRs) accounting for a substantial amount of [270 (68.53%)], [63 (73.26%)], and [35 (8.9%)], respectively. A total of 35 ADRs were reported; the majority of ADRs belonged to level 2. Mild ADRs [19 (54.29%)] and [16 (45.71%)] were classified as Level 3 moderate in nature. The number of comorbidities (OR:1.86 [1.0637-3.2637]) (p=0.03) and number of drugs (OR:1.89 [1.311-2.7117]) (p=0.019) were significant predictors of DRP occurrence.

Conclusions: The elderly heart failure patients often face polypharmacy and drug-related problems. Proactive deprescription and tailored combination therapies can reduce medication numbers. Monitoring for interactions and adverse reactions is vital, with clinical pharmacists playing a key role in optimizing care.