Zheutlin Alexander R, Jacobs Joshua A, Niforatos Joshua D, Chaitoff Alexander
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Pharmacotherapy. 2025 Mar;45(3):155-160. doi: 10.1002/phar.4648. Epub 2025 Jan 20.
Heart failure (HF) affects more than 6 million adults in the United States, contributing to substantial morbidity, mortality, and health care costs. Despite advances in medical care, many medications can exacerbate HF, yet their prevalence of use remains unknown. This study examined the national use of prescription medications that could exacerbate HF in adults with self-reported HF.
We analyzed data from US adults with self-reported HF in the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020. Medications known to exacerbate HF, identified from HF guidelines, were documented through pill bottle reviews. Weighted estimates were used to calculate prevalence overall and by sex, race and ethnicity, and level of evidence for avoidance. Multivariable logistic regression models calculated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for the use of these high-risk medications by sex and race and ethnicity.
A total of 687 participants, representing 5.2 million U.S. adults with HF after applying sampling weights, were included (mean age, 66.1 [95% CI 64.9, 67.4] years; 50.4% female [95% CI 45.9%, 55.0%]). Overall, 14.5% (95% CI 10.4%, 19.5%; n = 92) of adults with HF were prescribed at least one medication known to exacerbate HF, with the most common being diltiazem, meloxicam, and ibuprofen. Use of these medications was not significantly different by sex nor by race and ethnicity. Of these medications, 21.7% (95% CI 10.7%, 38.8%) had level A evidence warning against use, and 78.3% (95% CI 61.2%, 89.3%) had B level evidence.
Over one-seventh of U.S. adults with HF were likely to have been prescribed medications that could exacerbate the condition, underscoring the need to optimize care. Reducing high-risk medication use may mitigate HF exacerbations and improve outcomes in this vulnerable population.
在美国，心力衰竭（HF）影响着超过600万成年人，导致了大量的发病、死亡以及医疗费用。尽管医疗护理取得了进展，但许多药物会加重心力衰竭，然而它们的使用 prevalence 仍然未知。本研究调查了全国范围内在自我报告患有心力衰竭的成年人中可能加重心力衰竭的处方药的使用情况。
我们分析了2011年至2020年3月美国国家健康和营养检查调查（NHANES）中自我报告患有心力衰竭的美国成年人的数据。通过查看药瓶记录了已知会加重心力衰竭的药物，这些药物是从心力衰竭指南中确定的。加权估计用于计算总体患病率以及按性别、种族和族裔以及避免使用的证据级别计算的患病率。多变量逻辑回归模型计算了按性别、种族和族裔使用这些高风险药物的调整优势比（aORs）和95%置信区间（95% CIs）。
在应用抽样权重后，共纳入了687名参与者，代表了520万美国患有心力衰竭的成年人（平均年龄，66.1[95% CI 64.9, 67.4]岁；50.4%为女性[95% CI 45.9%, 55.0%]）。总体而言，14.5%（95% CI 10.4%, 19.5%；n = 92）的心力衰竭成年人被开具了至少一种已知会加重心力衰竭的药物，最常见的是地尔硫卓、美洛昔康和布洛芬。这些药物的使用在性别、种族和族裔方面没有显著差异。在这些药物中，21.7%（95% CI 10.7%, 38.8%）有A级证据警告避免使用，78.3%（95% CI 61.2%, 89.3%）有B级证据。
超过七分之一的美国心力衰竭成年人可能被开具了会加重病情的药物，这突出了优化护理的必要性。减少高风险药物的使用可能减轻心力衰竭的加重，并改善这一脆弱人群的治疗结果。
