Prevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study

Mai H Duong; Danijela Gnjidic; Andrew J McLachlan; Kevin Winardi; Alexandra A Bennett; Fiona Blyth; David Le Couteur; Sarah N Hilmer

doi:10.1111/imj.16612

Prevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study

Intern Med J. 2024 Dec 19. doi: 10.1111/imj.16612. Online ahead of print.

Authors

Mai H Duong^{1

2}, Danijela Gnjidic², Andrew J McLachlan², Kevin Winardi¹, Alexandra A Bennett^{2

3}, Fiona Blyth², David Le Couteur², Sarah N Hilmer^{1

2

3}

Affiliations

¹ Laboratory of Ageing and Pharmacology, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
² Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ NSW Therapeutic Advisory Group, Sydney, New South Wales, Australia.

PMID: 39698760
DOI: 10.1111/imj.16612

Abstract

Background: Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence.

Aims: To evaluate utilisation of HF pharmacotherapy and prevalence of polypharmacy, adverse drug events (ADEs), falls, delirium, renal impairment and duration of hospitalisation in older inpatients, according to frailty.

Methods: A retrospective cross-sectional study of the TO HOME cohort of 2000 inpatients ≥75 years admitted for ≥48 h to rehabilitation, geriatric or general medicine from 1 July 2016 to 30 June 2017 across six hospitals in Sydney, Australia. Data were collected from electronic medical records. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification identified HF diagnosis, ADEs and frailty using hospital frailty risk score. Outcomes included utilisation of HF pharmacotherapy; polypharmacy; ADEs, falls, delirium, renal and impairment; and duration of hospitalisation.

Results: Among 439 (22.0% of TO HOME cohort) patients with undifferentiated HF, 284 (69.5%) had intermediate or high risk of frailty, and 412 (94%) took ≥1 HF pharmacotherapy, with 357 (81.3%) patients on loop diuretics. Patients with high frailty risk frequently continued beta-blockers (70%) and discontinued renin-angiotensin system inhibitors (57%). Most patients experienced polypharmacy (n = 426, 97.0%). Renal impairment prevalence was 67%-76% across frailty groups. Increasing frailty risk (low, intermediate and high) was associated with increasing prevalence of ADEs (31%, 56% and 84%), falls (12%, 25% and 46%) and delirium (8%, 27% and 49%) and longer hospitalisation.

Conclusions: Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.

Keywords: congestive heart failure; data visualisation; drug utilisation; guideline adherence; observational study; polypharmacy.

Abstract

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