Cardiovascular Pharmacology: Open Access

Abstract

Polypharmacy is Associated with Co-morbidity and Predicts outcome in Patients undergoing Index Pulmonary Hypertension Assessment

Michael McGee, Avedis Ekmejian, Seshika Ratwatte, Allan Davies, Stuart Turner and Nicholas Collins

Aims: We sought to evaluate the incidence of polypharmacy in patients referred for pulmonary hypertension assessment, assess the relationship of polypharmacy to the presence of co-morbidity and document the influence of polypharmacy and co-morbidity on unplanned readmissions and mortality in this cohort.

Methods: We performed an audit of outpatient clinical medical records for 215 consecutive patients referred to a tertiary referral centre for pulmonary hypertension assessment between March 2009 and April 2016. Data on number and class of medications were recorded, as well as past medical history and investigations relevant to assessment of pulmonary hypertension.

Results: At the time of pulmonary hypertension evaluation, patients were prescribed a mean of 8 ± 4 medications with 83.2% of patients being on 5 or more regularly prescribed medications. Taking 8 or more medications was associated with co-morbidity, as assessed by the Charlson Co-morbidity Index, and reduced exercise capacity. The presence of co-morbidity resulted in a significantly higher risk of unplanned admission. The presence of polypharmacy is a marker of important co-morbidity, identifying a group at high risk.

Conclusion: Patients referred for assessment of pulmonary hypertension had high rates of polypharmacy reflecting extensive comorbidity, which in turn predicts adverse outcome in this patient population. The presence of polypharmacy should be considered a simple clinical marker of co-morbidity, increased risk and adverse outcome.