title: Trends in comorbidity, disability, and polypharmacy in heart failure.
abstract: BACKGROUND
  Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population.
  
  
  METHODS
  Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988-1994, 1999-2002, 2003-2008).
  
  
  RESULTS
  We identified 1395 participants with self-reported heart failure (n=581 in 1988-1994, n=280 in 1999-2002, n=534 in 2003-2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years.
  
  
  CONCLUSIONS
  The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Wong
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D019338:Polypharmacy; D011157:Population Dynamics; D012107:Research Design; D013997:Time Factors; D014481:United States / Q000453:epidemiology