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The Complexity and Cost of Drug Regimens of Older Patients Hospitalized With Heart Failure in the United States, 1998-2001
Frederick A. Masoudi, MD, MSPH;
Charles A. Baillie, MD;
Yongfei Wang, MS;
W. David Bradford, PhD;
John F. Steiner, MD, MPH;
Edward P. Havranek, MD;
JoAnne Micale Foody, MD;
Harlan M. Krumholz, MD, SM
Arch Intern Med. 2005;165:2069-2076.
Background Polypharmacy—the concurrent prescription of multiple medications—is a salient consideration in the care of older patients with heart failure. Little is known, however, about the complexity and financial burden of medical therapy in this population.
Methods This is a study of the chronic medications prescribed at hospital discharge to patients 65 years or older hospitalized for heart failure in 2 cohorts separated by 27 months (April 1998–March 1999, n = 31 602; July 2000–June 2001, n = 30 774). Three utilization measures were assessed: the number of drugs, the estimated number of doses per day, and the estimated annual costs using the same cost standard (2003 average wholesale prices) for both samples. Utilization associated with population characteristics and between time frames was assessed in multivariable models.
Results In 1998-1999, the mean number of drugs was 6.8, representing 10.1 doses daily at a cost of $3142/y, increasing to 7.5 drugs, 11.1 doses daily and $3823/y in 2000-2001 (P<.001 for all comparisons). After adjustment, the number of drugs increased by 12% and costs by 24% between samples. Factors associated with greater complexity and cost included diabetes (1.6 additional drugs and $1094/y additional cost), prior revascularization (1.3 drugs, $1154/y), and chronic lung disease (1.2 drugs, $814/y). Younger age and white race were also associated with more drugs and higher costs.
Conclusions The drug treatment of older patients with heart failure is characterized by rapidly increasing complexity and cost. Efforts should be directed toward optimizing the complex drug regimens of elderly patients with heart failure and multiple comorbidities.
Author Affiliations: Division of Cardiology, Department of Medicine, Denver Health Medical Center (Drs Masoudi and Havranek), and Divisions of Cardiology (Drs Masoudi and Havranek) and Geriatric Medicine (Dr Masoudi) and the Colorado Health Outcomes Program (Drs Masoudi and Steiner), Department of Medicine, University of Colorado Health Sciences Center, Denver; Section of Cardiovascular Medicine, Department of Internal Medicine (Drs Baillie,Foody, and Krumholz and Mr Wang), Robert Wood Johnson Clinical Scholars Program (Dr Krumholz), and Section of Health Policy and Administration, Department of Epidemiology and Public Health (Dr Krumholz), Yale University School of Medicine, New Haven, Conn; Department of Health Administration and Policy, Medical University of South Carolina, Charleston (Dr Bradford); Colorado Foundation for Medical Care, Aurora (Drs Masoudi, Havranek, and Krumholz); Section of Cardiology, Department of Medicine, West Haven Veteran’s Affairs Medical Center, West Haven, Conn (Dr Foody); and Center for Outcomes Research and Evaluation (Dr Krumholz), Yale-New Haven Hospital, New Haven.
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