Cobretti Michael R, Page Robert L, Linnebur Sunny A, Deininger Kimberly M, Ambardekar Amrut V, Lindenfeld JoAnn, Aquilante Christina L
Department of Pharmaceutical Sciences.
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO.
Clin Interv Aging. 2017 Apr 12;12:679-686. doi: 10.2147/CIA.S130832. eCollection 2017.
Heart failure prevalence is increasing in older adults, and polypharmacy is a major problem in this population. We compared medication regimen complexity using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool in "young-old" (60-74 years) versus "old-old" (75-89 years) patients with heart failure. We also compared pMRCI between patients with ischemic cardiomyopathy (ISCM) versus nonischemic cardiomyopathy (NISCM).
Medication lists were retrospectively abstracted from the electronic medical records of ambulatory patients aged 60-89 years with heart failure. Medications were categorized into three types - heart failure prescription medications, other prescription medications, and over-the-counter (OTC) medications - and scored using the pMRCI tool.
The study evaluated 145 patients (n=80 young-old, n=65 old-old, n=85 ISCM, n=60 NISCM, mean age 73±7 years, 64% men, 81% Caucasian). Mean total pMRCI scores (32.1±14.4, range 3-84) and total medication counts (13.3±4.8, range 2-30) were high for the entire cohort, of which 72% of patients were taking eleven or more total medications. Total and subtype pMRCI scores and medication counts did not differ significantly between the young-old and old-old groups, with the exception of OTC medication pMRCI score (6.2±4 young-old versus 7.8±5.8 old-old, =0.04). With regard to heart failure etiology, total pMRCI scores and medication counts were significantly higher in patients with ISCM versus NISCM (pMRCI score 34.5±15.2 versus 28.8±12.7, =0.009; medication count 14.1±4.9 versus 12.2±4.5, =0.008), which was largely driven by other prescription medications.
Medication regimen complexity is high in older adults with heart failure, and differs based on heart failure etiology. Additional work is needed to address polypharmacy and to determine if medication regimen complexity influences adherence and clinical outcomes in this population.
老年人心力衰竭患病率不断上升，而多重用药是该人群的一个主要问题。我们使用经过验证的患者层面用药方案复杂性指数（pMRCI）工具，比较了“年轻老年人”（60 - 74岁）与“高龄老年人”（75 - 89岁）心力衰竭患者的用药方案复杂性。我们还比较了缺血性心肌病（ISCM）患者与非缺血性心肌病（NISCM）患者的pMRCI。
回顾性提取60 - 89岁门诊心力衰竭患者电子病历中的用药清单。药物分为三类——心力衰竭处方药、其他处方药和非处方药（OTC）——并使用pMRCI工具进行评分。
该研究评估了145例患者（80例年轻老年人，65例高龄老年人，85例ISCM患者，60例NISCM患者，平均年龄73±7岁，64%为男性，81%为白种人）。整个队列的平均总pMRCI评分（32.1±14.4，范围3 - 84）和总用药数量（13.3±4.8，范围2 - 30）较高，其中72%的患者总共服用11种或更多药物。年轻老年人和高龄老年人组之间的总pMRCI评分和亚型pMRCI评分以及用药数量没有显著差异，但非处方药pMRCI评分除外（年轻老年人为6.2±4，高龄老年人为7.8±5.8，P = 0.04）。关于心力衰竭病因，ISCM患者的总pMRCI评分和用药数量显著高于NISCM患者（pMRCI评分34.5±15.2对28.8±12.7，P = 0.009；用药数量14.1±4.9对12.2±4.5，P = 0.008），这在很大程度上是由其他处方药导致的。
老年心力衰竭患者的用药方案复杂性较高，且因心力衰竭病因不同而有所差异。需要开展更多工作来解决多重用药问题，并确定用药方案复杂性是否会影响该人群的依从性和临床结局。
