title: The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998-2001.
abstract: BACKGROUND
  Polypharmacy-the concurrent prescription of multiple medications-is a salient consideration in the care of older patients with heart failure. Little is known, however, about the complexity and financial burden of medical therapy in this population.
  
  
  METHODS
  This is a study of the chronic medications prescribed at hospital discharge to patients 65 years or older hospitalized for heart failure in 2 cohorts separated by 27 months (April 1998-March 1999, n = 31 602; July 2000-June 2001, n = 30,774). Three utilization measures were assessed: the number of drugs, the estimated number of doses per day, and the estimated annual costs using the same cost standard (2003 average wholesale prices) for both samples. Utilization associated with population characteristics and between time frames was assessed in multivariable models.
  
  
  RESULTS
  In 1998-1999, the mean number of drugs was 6.8, representing 10.1 doses daily at a cost of 3142 dollars/y, increasing to 7.5 drugs, 11.1 doses daily and 3823 dollars/y in 2000-2001 (P<.001 for all comparisons). After adjustment, the number of drugs increased by 12% and costs by 24% between samples. Factors associated with greater complexity and cost included diabetes (1.6 additional drugs and 1094 dollars/y additional cost), prior revascularization (1.3 drugs, 1154 dollars/y), and chronic lung disease (1.2 drugs, 814 dollars/y). Younger age and white race were also associated with more drugs and higher costs.
  
  
  CONCLUSIONS
  The drug treatment of older patients with heart failure is characterized by rapidly increasing complexity and cost. Efforts should be directed toward optimizing the complex drug regimens of elderly patients with heart failure and multiple comorbidities.
authors.affiliation: Division of Cardiology, Department of Medicine, Denver Health Medical Center, CO 80204, USA. fred.masoudi@uchsc.edu
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Charles A
authors.initials: CA
authors.lastname: Baillie
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: W David
authors.initials: WD
authors.lastname: Bradford
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: JoAnne Micale
authors.initials: JM
authors.lastname: Foody
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016527:Drug Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics*; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D012189:Retrospective Studies; D014481:United States