Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies?

BACKGROUND

Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice.

AIM

The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples.

METHODS

The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects.

RESULTS

Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them.

CONCLUSIONS

The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.

Polypharmacy among elderly patients in Poland: prevalence, predisposing factors, and management strategies

INTRODUCTION

The world's elderly population is growing dramatically. Pharmacotherapy in seniors is particularly challenging due to changes in metabolism, multimorbidity, and a great interest in nonprescription drugs.

OBJECTIVES

We aimed to provide up‑to‑datedata on pharmacotherapy in the geriatric population of Poland, to determine factors predisposing to polypharmacy and excessive polypharmacy, and to identify seniors who are most likely to require multidisciplinary interventions in the field of pharmacotherapy.

PATIENTS AND METHODS

We analyzed the use of all prescription and nonprescription drugs taken within 2 weeks preceding the study in a representative national sample of 3014 home‑dwelling seniors aged over 65 years. The variables of age, sex, place of residence, level of education, and multimorbidity were considered. Poststratification was used to balance the sample structure to match the Polish population of 2017.

RESULTS

Consumption of at least 1 drug was reported by 90.7% of the participants, and the mean number of drugs used was 5.01 (95% CI, 4.87-5.15). At least 1 nonprescription drug was used by 44.2% of the respondents, with a mean number of 0.52 (95% CI, 0.49-0.55). More than 5 drugs were taken by 53.5% of the entire population, while the use of more than 10 drugs was reported by 8.7% of the respondents, with multimorbidity as the most predisposing factor. Single‑pill combinations accounted for 27.2% of medications.

CONCLUSIONS

The high prevalence of polypharmacy resulting from multimorbidity confirms the need for the implementation of combined medical and pharmaceutical care of the geriatric patients.

Prevalence and factors predisposing to potential drug-drug interactions in a Polish community-dwelling geriatric population: An observational, cross-sectional study

BACKGROUND

Due to advanced age, multimorbidity and polypharmacotherapy, older patients are predisposed to drug interactions and the adverse effects of inappropriate drug combinations.

OBJECTIVES

To provide up-to-date data on predisposing factors and the prevalence of possible drug interactions in the Polish geriatric population and to promote automated analysis programs as part of safe pharmacotherapy.

MATERIAL AND METHODS

We used the Lexicomp® Drug Interactions database to assess pharmacological interactions between active substances included in all types of preparations (prescription drugs, over-the-counter drugs, vitamins, nutritional preparations, and dietary supplements) used at least once in the 2 weeks preceding the study, among 2633 home-dwelling people aged >65 years. The variables measured included age, sex, place of residence, level of education, and multimorbidity. Post-stratification was used to weigh the sample structure against the Polish population in 2017.

RESULTS

Drug interactions were identified in 81.2% of all individuals. The mean number (with 95% confidence interval (95% CI)) of all drug interactions was 4.24 (4.02-4.46), and the median value (with 1st and 3rd quartiles (Q1-Q3)) was 3 (1-6). At least 1 category C interaction was observed in 75.8% of all study participants, 24.3% had 1 or more category D interaction, and 4.3% had 1 or more category X interaction. The most important predisposing factor to drug interactions was multimorbidity.

CONCLUSIONS

This study identified a high prevalence of potential drug interactions in the Polish geriatric population. Automated analysis systems deliver useful information on pharmacological interactions and should be promoted in the Polish healthcare community as tools to support pharmacotherapy.