Killing with Prescriptions

As many as 50% patients diagnosed with heart failure are taking drugs that will make heart failure worse. In fact, after hospitalization, 12% of patients with heart failure were taking more harmful drugs than when they were admitted.

Heart failure is the topic of the research article that is the subject of this post. However, what applies to heart failure may apply to other diseases.

The key terms are

  • Polypharmacy — simply, taking lots of different drugs, perhaps too many of them
  • Medication review and optimization — making sure the mix of medications is appropriate for the patient, and what’s appropriate is likely to change over time
  • De-prescribing — weening patients off medication that may no longer be of value or may actually be harmful

“Medications that can worsen heart failure are commonly used in older adults with heart failure,” lead author Parag Goyal, MD, MSc, assistant professor of medicine, division of cardiology, and director of the HFpEF Program at Weill Cornell Medicine, New York City, told theheart.org | Medscape Cardiology. (1)

Some of the drugs that cause problems with heart failure are commonly used to treat other diseases such as diabetes. Examples include:

  • Metformin, used to reduce high blood sugar levels
  • Ibuprofen for pain
  • Albuterol for chronic obstructive pulmonary disease (COPD)

This isn’t something you can just read; you need to talk with your doctor AND your pharmacist regarding the drugs you are taking. If you don’t have a pharmacist, it’s time to get to know one.

If you’re doctor won’t take the time to discuss this, find another one. If you’re taking a lot of medications (6 or more), it might be time to get a second opinion from an independent doctor.

Don’t change your medication without talking to a doctor about it. However, managing your health isn’t a passive activity. You’re entitled to answers, and you need to reach out to get them.

Sources:

  1. https://www.medscape.com/viewarticle/921095?src=WNL_infoc_191222_MSCPEDIT_TEMP2&uac=153634BV&impID=2212444&faf=1#vp_1
  2. JACC Heart Failure. Published online November 6, 2019. Abstract

4 comments

  1. Mr Crain you raise a thoughtful and compelling argument for the average patient who may have questions about his prescribed medications in the face of evidence that it may cause harm.

    Consumers are now more educated about prospective therapies and must be encouraged to understand the narrative of the prescribed treatment and the potential risks including damage to heart muscle from congestive heart failure. The interaction of the common medications you mention in your essay with targeted therapy for CHF needs to be deconstructed by the physician and the pharmacist.

    Elderly patients commonly are prescribed medications that are contraindicated with ongoing treatment for a co-occurring illness or disease. What is a consumer to do when common sense says “something is wrong“.

    Like

    • The senior consumer needs an advocate — a close friend or family member — to observe and fight when needed. Despite stereotypes, as seniors age their willingness and ability to assert themselves fades.
      I see this when writing Medicare insurance for clients. I need drug information in order to calculate total out of pocket costs under different plans. And, frankly, some of what I see is pretty scary. When a patient is on three different meds for high blood pressure and still has HBP, you have to wonder about quality of care.

      Like

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