BMJ  2003;327:513-514 (6 September), doi:10.1136/bmj.327.7414.513

Editorial

Polypharmacy and comorbidity in heart failure

Most patients have comorbidities that need to be addressed

The first 150 words of the full text of this article appear below.

The care of patients with heart failure has become increasingly complex. For some patients treatment based on evidence and recommended by guidelines now includes agents that prolong life, alleviate symptoms, and reduce admissions to hospital.^{1 2} Simultaneously, the treatment of underlying causative factors, including hypertension, coronary artery disease, and dyslipidaemia has evolved rapidly, increasing the number of pharmacological agents that are considered necessary for many patients with heart failure. The characteristics of the typical patient further complicate management. The burden of heart failure falls disproportionately on elderly people, who often are simultaneously afflicted with many other conditions.^{3 4} In a recent study of older Americans admitted to hospital with heart failure, diabetes (38%), chronic lung disease (33%), atrial fibrillation (30%), and prior stroke (18%), were remarkably common.⁵ Thus practitioners typically face the challenge of managing not a single condition but multiple conditions requiring multiple medications. As the population ages this scenario will . . . [Full text of this article]

Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, CO 80204 USA

Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8025, USA (harlan.krumholz@yale.edu)

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This article has been cited by other articles:

• Field, K., Ziebland, S., McPherson, A., Lehman, R. (2006). 'Can I come off the tablets now?' A qualitative analysis of heart failure patients' understanding of their medication. Fam Pract 23: 624-630 [Abstract] [Full text]  
• Green, D. J., Maiorana, A. J., Siong, J. H. J., Burke, V., Erickson, M., Minson, C. T., Bilsborough, W., O'Driscoll, G. (2006). Impaired skin blood flow response to environmental heating in chronic heart failure. Eur Heart J 27: 338-343 [Abstract] [Full text]  
• Masoudi, F. A., Baillie, C. A., Wang, Y., Bradford, W. D., Steiner, J. F., Havranek, E. P., Foody, J. M., Krumholz, H. M. (2005). The Complexity and Cost of Drug Regimens of Older Patients Hospitalized With Heart Failure in the United States, 1998-2001. Arch Intern Med 165: 2069-2076 [Abstract] [Full text]  
• Gurwitz, J. H. (2004). Polypharmacy: A New Paradigm for Quality Drug Therapy in the Elderly?. Arch Intern Med 164: 1957-1959 [Full text]  

Rapid Responses:

Read all Rapid Responses

Penicillin and anticoagulation instead of polypharmacy!

Friedrich Flachsbart
bmj.com, 10 Sep 2003 [Full text]

Management of chronic heart failure should be based in primary care.

Robert G Marriott
bmj.com, 12 Sep 2003 [Full text]

Heart failure and Co-morbidity

Kalman Kafetz
bmj.com, 25 Sep 2003 [Full text]