Heart drug therapy complex, costly for elderly
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Because elderly patients with heart failure are faced with ever more complex and expensive medication regimens, more effort should go into optimizing their treatment, according to a new report.
“Physicians should be aware of the drug regimens they are expecting their patients to take,” Dr. Frederick A. Masoudi from Denver Health Medical Center, Colorado told Reuters Health. “They should consider the number of drugs they prescribe, the complexity of these regimens, and what their patients must pay to obtain them.”
Masoudi and colleagues studied patterns of medication prescriptions for older Medicare beneficiaries hospitalized with heart failure between 1998 and 2001.
Between 1998-1999 and 2000-2001, the average number of chronic medications prescribed for these patients increased from 6.8 to 7.5, and the mean daily number of doses increased from 10.1 to 11.1, the investigators report in the Archives of Internal Medicine.
The average estimated annual cost of these regimens increased by 22 percent between the two periods, the report indicates, from $3,142 to $3,823.
Substantial increases were seen between the two periods in prescriptions for beta-blockers, statins, and potassium-sparing diuretics, the results indicate. The most substantial change in prescriptions was for proton-pump inhibitors, which increased from 14.4 percent of the population to 22.3 percent.
Black patients received significantly fewer medicines than white patients, the investigators report, and patients under care of a cardiologist or a board-certified physician were treated with more medications at a higher cost.
“Clinicians should routinely review their patients’ regimens and consider the justification for each drug, and every effort should be made to simplify wherever possible, with the goal of achieving drug regimens for every patient that are as simple and affordable as possible,” Masoudi said.
“This study highlights, among other things, the importance of efforts to make drugs affordable for elderly persons,” Masoudi concluded. “The inability to pay for medications is a central cause of non-adherence, which in turn renders any drug regimen useless.”
SOURCE: Archives of Internal Medicine, October 10, 2005.
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