Characterising disease and prescribing patterns in people with heart failure and multiple chronic conditions: a single-centre descriptive cohort study

Introduction: Heart failure (HF) is a complex condition often accompanied by comorbidities such as renal dysfunction, diabetes mellitus (DM), chronic respiratory diseases, frailty, and anaemia, necessitating intricate management involving multiple therapeutics. Objectives: This retrospective cohort study aims to characterize prescribing patterns and identify potentially inappropriate polypharmacy in individuals with HF and multimorbidity. Methods: Data was collected from 234 HF adults with multimorbidity under the care of the HF multidisciplinary team at Liverpool University Hospital Foundation Trust (LUHFT) from January 2020 -February 2021. Results: The mean age was 71.5±13.9 and 44% were female. ACCI was 6.9±3.3, CFS was 5.5±3.2, polypharmacy burden was high at 10.2±3.9, and ACB was 1.45±0.9. ACB was higher in those with CFS≥6 vs. those with CFS<6 (1.5±1.1 vs. 1.1±0.9; p=0.02). The proportion of adults with HF on treatment for depression was 19.7%, chronic pain 35%, and chronic constipation 19.7%. Fifteen percent received oral iron instead of the appropriate intravenous iron replacement, while 17.9% of the cohort were observed to be nearing the end of their lives. Regarding PIM use, 9% were on either DAPT/anticoagulant plus anti-platelet therapy beyond 12 months of an acute coronary event. One in five patients received PPIs without clear justification. Conclusion: Adults with frailty and HF have a higher ACB. This study identifies targets for de-prescribing interventions in HF, including inappropriate PPI and DAPT/anticoagulant plus anti-platelet therapy, which are seeing in 1:5 and 1:10 adults with HF in the clinic, respectively. Tailored guidelines can aid shared decision-making, reducing drug-related complications in this group.