Patterns of medication changes between admission and dischage of hospitalized elderly patients with congestive heart failure

Objective: Approximately 33% of 13.2 million hospitalizations/year are attributed to the elderly, with the most common cause of medical hospitalization being congestive heart failure (CHF), which is primarily managed with medication adjustment. This study aims to assess the patterns of changes in the number of medications prescribed to elderly CHF patients in a hospital setting, from time of admission to the time of discharge. Methodology: Data, from Medicare (65 years or older) CHF patients admitted to Long Island Jewish Medical Center, a large tertiary acute care center, in 2005 (N=402), were analyzed. This study compares the medication profile at admission with the medication profile at discharge. Specifically the study aims to compare the proportion of polypharmacy users (>9 medications) upon admission to the proportion at discharge. Results: The average age of patients was 78 years (65-88 years); Most were either White (65%) or Black (22%), with equal portion of men and women. The average length of hospital stay was 2-3 days. On admission, 46% of patients were polypharmacy users, while 80.5% were polypharmacy users at hospital discharge (p<.001). On admission, 188 patients (46%) had over 9 medications, 12% were on a total of 6-8 medications, 2.9% were on 4-5 medications and 19.6% had a total of 1-3 medications. Surprisingly, 18% of these elderly CHF patients were on no medications at time of hospitalization. On discharge, 2.2% of elderly CHF patients had a total of 1-3 medications, 2.7% had a total of 4-5 medications; 13.9% were discharged on a total of 6-8 medications and 80.5% (324 patients) had a total of >9 medications, ranging from 9 to 23 medications (p<0.001). Conclusion: In this retrospective study of hospitalized elderly patients with CHF, patients had an overall increase in the number of medications from admission to discharge. Furthermore, the proportion of patients receiving polypharmacy increased from admission to discharge. This implies (since the primary management of CHF is based on medication adjustment) the increased burden associated by polypharmacy needs to be addressed to ensure appropriate compliance to medications and thus optimal patient outcomes.