Intended for healthcare professionals


Polypharmacy and comorbidity in heart failure

BMJ 2003; 327 doi: (Published 04 September 2003) Cite this as: BMJ 2003;327:513
  1. Frederick A Masoudi, assistant professor of medicine,
  2. Harlan M Krumholz, professor of medicine (cardiology) (
  1. Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, CO 80204 USA
  2. Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8025, USA

    Most patients have comorbidities that need to be addressed

    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 …

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