The Effect Of Polypharmacy And Polypharmacy Risk On Patients Admitted With Heart Failure With Preserved Ejection Fraction

Background Patients hospitalized with heart failure with preserved ejection fraction (HFpEF) commonly require medications for multiple comorbid conditions. While they do not require guideline directed medical therapy such as heart failure with reduced ejection fraction (HFrEF), they are still at risk for polypharmacy. We aim to demonstrate the benefit of acknowledged polypharmacy or polypharmacy risk in patients hospitalized with diastolic heart failure. Methods Patient data was collected for years 2011-2018 from the National inpatient Sample (NIS) using International Classification of Disease-Revision Codes (ICD-9 and 10). We selected patients hospitalized with a primary diagnosis of HFpEF, polypharmacy and polypharmacy risk with ICD Coding. Multivariate hierarchical logistic regression was used to determine adjusted odds ratios (AOR) to derive confidence intervals and associated risk. Mann-Whitney U testing was utilized to calculate mean differences in age, length of stay (LOS), and total hospital charges. Results A total of 365,522 were included in our analysis. 30,655 patients had a diagnosis conferring polypharmacy or increased polypharmacy risk. We found that patients with a diagnosis of polypharmacy had a decreased risk of mortality by 41% (CI 0.53-0.65, P<0.05). Women had a higher chance of being diagnosed with polypharmacy compared to men by 3.8%(CI 1.01-1.064. P< 0.05). Private payers had a 25% higher chance of carrying a polypharmacy diagnosis compared to Medicare (CI 1.19-1.30, P<0.05). Hispanics had a 23% decreased chance of being diagnosed with polypharmacy compared to Caucasians (CI 0.73-0.82, P <0.05). Native Americans exhibited a 31% increase in chance of being diagnosed with polypharmacy (CI 1.11-1.54, P<0.05). Urban teaching hospitals had a 41% decreased chance in diagnosing patients with polypharmacy compared to rural (CI 0.57-0.61, P<0.05). Mann-Whitney U testing revealed patients with a diagnosis of polypharmacy had a decreased mean LOS and hospitalization charges compared to those who did not (P<0.01). Pearson correlation analysis did show the mean percent of patients diagnosed with polypharmacy was increasing over time (P<0.01). Conclusions We found improved outcomes in patients with documented polypharmacy or polypharmacy risk among patients hospitalized with a primary diagnosis of diastolic heart failure. While ICD coding itself does not confer improved quality of care, we suspect that documentation of patient risk is associated with improved outcomes. We did observe racial disparities given this possible benefit. Additionally urban teaching institutions demonstrated suboptimal polypharmacy risk assessment compared to rural. Patients hospitalized with heart failure with preserved ejection fraction (HFpEF) commonly require medications for multiple comorbid conditions. While they do not require guideline directed medical therapy such as heart failure with reduced ejection fraction (HFrEF), they are still at risk for polypharmacy. We aim to demonstrate the benefit of acknowledged polypharmacy or polypharmacy risk in patients hospitalized with diastolic heart failure. Patient data was collected for years 2011-2018 from the National inpatient Sample (NIS) using International Classification of Disease-Revision Codes (ICD-9 and 10). We selected patients hospitalized with a primary diagnosis of HFpEF, polypharmacy and polypharmacy risk with ICD Coding. Multivariate hierarchical logistic regression was used to determine adjusted odds ratios (AOR) to derive confidence intervals and associated risk. Mann-Whitney U testing was utilized to calculate mean differences in age, length of stay (LOS), and total hospital charges. A total of 365,522 were included in our analysis. 30,655 patients had a diagnosis conferring polypharmacy or increased polypharmacy risk. We found that patients with a diagnosis of polypharmacy had a decreased risk of mortality by 41% (CI 0.53-0.65, P<0.05). Women had a higher chance of being diagnosed with polypharmacy compared to men by 3.8%(CI 1.01-1.064. P< 0.05). Private payers had a 25% higher chance of carrying a polypharmacy diagnosis compared to Medicare (CI 1.19-1.30, P<0.05). Hispanics had a 23% decreased chance of being diagnosed with polypharmacy compared to Caucasians (CI 0.73-0.82, P <0.05). Native Americans exhibited a 31% increase in chance of being diagnosed with polypharmacy (CI 1.11-1.54, P<0.05). Urban teaching hospitals had a 41% decreased chance in diagnosing patients with polypharmacy compared to rural (CI 0.57-0.61, P<0.05). Mann-Whitney U testing revealed patients with a diagnosis of polypharmacy had a decreased mean LOS and hospitalization charges compared to those who did not (P<0.01). Pearson correlation analysis did show the mean percent of patients diagnosed with polypharmacy was increasing over time (P<0.01). We found improved outcomes in patients with documented polypharmacy or polypharmacy risk among patients hospitalized with a primary diagnosis of diastolic heart failure. While ICD coding itself does not confer improved quality of care, we suspect that documentation of patient risk is associated with improved outcomes. We did observe racial disparities given this possible benefit. Additionally urban teaching institutions demonstrated suboptimal polypharmacy risk assessment compared to rural.