Patients with heart failure are older, have more illnesses, and take more medications than earlier
Research Activities, August 2011, No. 372
Patients with heart failure are older and their care is commonly complicated by disability, the presence of other illnesses, and multiple medications compared with 20 years ago, reveals a new survey. It found that the proportion of patients 80 years of age or older significantly jumped from 13 percent in 1988-1994 to 22 percent in 2003-2008. In the same period, the proportion of patients with heart failure who had 5 or more other illnesses grew from 42 percent to 58 percent and prescription drug use increased from a mean of 4.1 to 6.4 prescriptions.
A rising proportion of patients with heart failure have high cholesterol (42 to 54 percent), diabetes (25 to 38 percent), obesity (33 to 47 percent), kidney disease (35 to 46 percent), thyroid disease (10 to 23 percent), and osteoporosis (5 to 16 percent). Patients with heart failure are taking an increasing amount of both cardiovascular and non-cardiovascular medications. The proportion of these patients with disability did not change over time, but was significant throughout. In 2003-2008, 57 percent of patients aged 60 and over had impaired mobility; 11 percent had limitations in activities of daily living; and 12 percent were vision-impaired.
These findings were based on analysis of data from the National Health and Nutrition Examination Survey. The researchers identified 1,395 participants with heart failure (581 in 1988-1994, 280 in 1999-2002, and 534 in 2003-2008). They believe that the growing complexity of patients with heart failure demonstrates a need to fundamentally change the way we research and care for these patients. The very elderly, with multiple medical conditions and on multiple medications, are inadequately studied in clinical trials. As patients with heart failure grow increasingly complex, physicians will need to improve their ability to prioritize treatment recommendations based on relative benefits and harms and in the context of patient preferences.
See "Trends in comorbidity, disability, and polypharmacy in heart failure," by Catherine Y. Wong, B.S., Sarwat I. Chaudhry, M.D., Mayur M. Desai, Ph.D., and Harlan M. Krumholz, M.D., in the February 2011 The American Journal of Medicine 124, pp. 136-143.