![]() ![]() In the general population, patients with ≥5 chronic conditions have an average of 14 physician visits per year compared with only 1.5 for those with no chronic conditions. As the burden of noncardiovascular comorbidities increases, the number of medications, medication costs, and complexity also may increase. In an analysis of noncardiac comorbidity in 122 630 Medicare beneficiaries, Braunstein et al 8 found that diabetes mellitus (31%), chronic obstructive pulmonary disease (26%), ocular disorders (24%), osteoarthritis (16%), and thyroid disorders (14%) predominated. From this analysis, osteoarthritis (62%), obesity (46.8%), chronic kidney disease (45.9%), and diabetes mellitus (38.3%) were the most common noncardiovascular comorbidities. 6 Using the National Health and Nutrition Examination Survey, Wong et al 7 found that the proportion of patients with ≥5 comorbidities increased from 42.1% in the period of 1988 to 1994 to 58% in the period of 2003 to 2008. This estimate is much higher compared with the general Medicare population, in which only 7.6% have ≥3 chronic conditions. Five or more cardiovascular and noncardiovascular chronic conditions are present in 40% of Medicare patients with HF. The HF syndrome is accompanied by a broad spectrum of both cardiovascular and noncardiovascular comorbidities. Some of the reasons may be related to the increasing number of guideline-directed medications for HF and other comorbidities, as well as the increasing comorbidity burden in an aging population that may warrant an increasing number of specialist and provider visits. The reasons for polypharmacy among patients with HF can be both complex and multifactorial. ![]() 3 When prescription and OTC medications and CAM use are taken into account, polypharmacy may be universal in patients with HF. In a single-center study of 161 patients with HF, 88% reported using OTC medications, 34.8% took herbal supplements, and 65.2% took vitamins.īy definition, polypharmacy is the long-term use of ≥5 medications. Unfortunately, the information on the prevalence of OTC and CAM use in patients with HF is limited. Older adults are the largest consumers of OTC medications, taking on average 4 OTC medications per day. With many prescription medications switching to OTC status, the consumption of OTC products appears to be increasing. 2 More than 15 million Americans consume vitamins or CAMs, especially those with chronic illnesses. This estimate does not include over-the-counter (OTC) medications or complementary and alternative medications (CAMs). On average, HF patients take 6.8 prescription medications per day, resulting in 10.1 doses a day. Patients with HF often have a high medication burden consisting of multiple medications and complex dosing regimens. It is likely that the prevention of drug-drug interactions and direct myocardial toxicity would reduce hospital admissions, thus both reducing costs and improving quality of life. 1 Hospitalization for HF is the largest segment of those costs. ![]() The estimated cost for treatment of HF in Medicare recipients is $31 billion and is expected to increase to $53 billion by 2030. Heart failure (HF) remains the leading discharge diagnosis among patients ≥65 years of age. ![]()
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