Trends in Comorbidity, Disability, and Polypharmacy in Heart Failure - 19/08/11
Abstract |
Background |
Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population.
Methods |
Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988-1994, 1999-2002, 2003-2008).
Results |
We identified 1395 participants with self-reported heart failure (n=581 in 1988-1994, n=280 in 1999-2002, n=534 in 2003-2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years.
Conclusion |
The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.
Le texte complet de cet article est disponible en PDF.Keywords : Comorbidity, Disability, Epidemiology, Heart failure, Polypharmacy
Plan
Funding: Catherine Wong is a research fellow supported by Sarnoff Cardiovascular Research Foundation. Dr. Chaudhry is supported by a K23/Beeson Career Development Award from the National Institute on Aging and the American Federation for Aging Research. Dr. Krumholz is supported by grant 1R01 HL081153-03 from the National Heart, Lung, and Blood Institute, and grant 1R01 HS016929-02 from the Agency for Healthcare Research and Quality and the United Health Foundation. We did not receive any additional funding, including pharmaceutical industry funds, for the preparation of this manuscript or any related research. |
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Conflict of Interest: All authors report no conflicts of interest. |
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Authorship: Catherine Wong was affiliated with Yale University as a Sarnoff Cardiovascular Research Fellow during the time the work was conducted. All authors had access to the data and a role in writing the manuscript. |
Vol 124 - N° 2
P. 136-143 - février 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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