title: Co-morbidity and potential treatment conflicts in elderly heart failure patients: a retrospective, cross-sectional study of administrative claims data.
abstract: BACKGROUND
  Co-morbidity of both cardiac and non-cardiac conditions is common in the elderly with heart failure (HF) and can be associated with adverse clinical outcomes.
  
  
  OBJECTIVE
  The aims of this study were to examine the prevalence of co-morbidity and potential treatment conflicts that may result in adverse clinical outcomes in a large cohort of elderly HF patients.
  
  
  METHODS
  We conducted a cross-sectional study using administrative claims data (1 April to 31 July 2007) from the Department of Veterans' Affairs, Australia, on all veterans aged ≥65 years with HF. Co-morbidities were defined using the pharmaceutical based co-morbidity index Rx-Risk-V. Potential treatment conflicts for patients with HF and co-morbid diseases were identified from Australian clinical guidelines or reference compendia and their prevalence in the data were determined.
  
  
  RESULTS
  A total of 6730 patients were included in the study, with a median of 6 co-morbid conditions (interquartile range [IQR] 4-7) and 11 (IQR 8-15) unique medicines. Almost the entire HF cohort (97.8%) were identified as having at least one co-morbid condition that may cause a potential treatment conflict, with 55% having three or more. The conditions identified as being of greatest concern, based on their prevalence and potential for treatment conflict, were chronic airways disease, depression, chronic pain/inflammatory disease, glaucoma, diabetes mellitus and diseases treatable with corticosteroids.
  
  
  CONCLUSIONS
  Potential treatment conflicts are common in the highly co-morbid population of elderly patients with HF, and may influence the therapeutic management of not only HF but all conditions present.
authors: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia. gillian.caughey@unisa.edu.au
authors: Gillian E
authors: GE
authors: Caughey
authors: Elizabeth E
authors: EE
authors: Roughead
authors: Sepehr
authors: S
authors: Shakib
authors: Agnes I
authors: AI
authors: Vitry
authors: Andrew L
authors: AL
authors: Gilbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006077:Government Agencies / Q000458:organization & administration / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome