Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
J Am Geriatr Soc. 2019 Feb;67(2):284-291. doi: 10.1111/jgs.15654. Epub 2018 Nov 29.
To determine whether the number of medications taken by adults with heart failure (HF) and impairment in activities of daily living (ADL)-a subpopulation in whom the risks of a high medication burden may outweigh the benefits-differs from the number taken by those without impairment in ADLs.
Cross-sectional.
National Health and Nutrition Examination Survey (NHANES; 2003-2014), a cross-sectional survey that produces national estimates of adults in the United States.
Adults aged 50 and older (mean 70) with self-reported HF (N= 947; representing 4.6 million adults with HF in the United States.
We assessed ADL impairment and medication count based on self-report. ADL impairment was defined as having difficulty with or being unable to dress, feed oneself, or get in and out of bed. To determine the independent association between ADL impairment and medication count, we performed sequential Poisson multivariable regression analyses. All analyses were cross-sectional in nature and accounted for the complex survey design of NHANES.
Mean medication count was 7.2, and 74% of participants were taking 5 or more medications (polypharmacy). In a multivariable model, ADL impairment was not independently associated with medication count. These findings were similar for those with 3 or more hospitalizations in the prior year, declining health status, and cognitive impairment.
After adjusting for confounders including comorbidity, we found that adults with HF and ADL impairment take as many medications as those without ADL impairment. This suggests that providers may not sufficiently consider functional impairment when prescribing medications to adults with HF and thus may unnecessarily expose individuals to risk of adverse outcomes. J Am Geriatr Soc 67:284-291, 2019.
确定患有心力衰竭（HF）和日常生活活动（ADL）受损的成年人（这一亚人群的高药物负担风险可能大于获益）服用的药物数量是否与无 ADL 受损的成年人不同。
横断面研究。
全国健康与营养调查（NHANES；2003-2014 年），这是一项横断面调查，可产生美国成年人的全国估计数。
年龄在 50 岁及以上（平均 70 岁），自述患有 HF（N=947；代表美国 460 万 HF 成年人）。
我们根据自我报告评估 ADL 受损和药物计数。ADL 受损定义为穿衣、进食、上下床有困难或无法完成。为了确定 ADL 受损与药物计数之间的独立关联，我们进行了顺序泊松多变量回归分析。所有分析均为横断面性质，并考虑了 NHANES 的复杂调查设计。
平均药物计数为 7.2，74%的参与者服用 5 种或更多药物（多种药物治疗）。在多变量模型中，ADL 受损与药物计数无独立相关性。这些发现对于过去一年有 3 次或更多次住院、健康状况下降和认知障碍的患者也是如此。
在调整了包括合并症在内的混杂因素后，我们发现 HF 和 ADL 受损的成年人服用的药物与无 ADL 受损的成年人一样多。这表明，在为 HF 成年人开处方时，医生可能没有充分考虑到功能障碍，从而可能使个体不必要地面临不良后果的风险。J Am Geriatr Soc 67：284-291，2019。
