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Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist.

ABSTRACT: Heart failure (HF) is a common health condition that typically affects older adults. Many people with HF are cared for on an inpatient basis, by noncardiologists, such as acute medical physicians, geriatricians and other physicians. Treatment options for HF are ever increasing, and adherence to guidelines for prognostic therapy contributes to polypharmacy, which is very familiar to clinicians who care for older people. This article explores the recent trials in both HF with reduced ejection fraction and HF with preserved ejection fraction and the limitations of international guidance in their management with respect to older people. In addition, this article discusses the challenge of managing polypharmacy in those with advanced age, and the importance of involving a geriatrician and pharmacist in the HF multidisciplinary team to provide a holistic and person-centred approach to optimisation of HF therapies.

SUBMITTER: Stefil M

PROVIDER: S-EPMC9987511 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist.

Stefil Maria M Dixon Matthew M Bahar Jameela J Saied Schabnam S Mashida Knievel K Heron Olivia O Shantsila Eduard E Walker Lauren L Akpan Asangaedem A Lip Gregory Yh GY Sankaranarayanan Rajiv R

Cardiac failure review 20220101

Heart failure (HF) is a common health condition that typically affects older adults. Many people with HF are cared for on an inpatient basis, by noncardiologists, such as acute medical physicians, geriatricians and other physicians. Treatment options for HF are ever increasing, and adherence to guidelines for prognostic therapy contributes to polypharmacy, which is very familiar to clinicians who care for older people. This article explores the recent trials in both HF with reduced ejection frac ...[more]

PMID: 36891063

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Project description:BackgroundPolypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy.AimTo conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended.MethodThe mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process.ResultsThe intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention.ConclusionThe study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy.Trial registration numberACTRN12621000268842 Date registered: 11/03/2021.

Dataset Information

Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist.

Publications

Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist.

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