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Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience.

Publication ,  Journal Article
Granger, BB; Tulsky, JA; Kaufman, BG; Clare, RM; Anstrom, K; Mark, DB; Johnson, KA; Patel, CB; Fiuzat, M; Steinhauser, K; O'connor, C ...
Published in: J Card Fail
February 2022

BACKGROUND: Palliative care (PC) in advanced heart failure (HF) aims to improve symptoms and quality of life (QOL), in part through medication management. The impact of PC on polypharmacy (>5 medications) remains unknown. METHODS AND RESULTS: We explored patterns of polypharmacy in the Palliative Care in HF (PAL-HF) randomized controlled trial of standard care vs interdisciplinary PC in advanced HF (N = 150). We describe differences in medication counts between arms at 2, 6, 12, and 24 weeks for HF (12 classes) and PC (6 classes) medications. General linear mixed models were used to evaluate associations between treatment arm and polypharmacy over time. The median age of the patients was 72 years (interquartile range 62-80 years), 47% were female, and 41% were Black. Overall, 48% had ischemic etiology, and 55% had an ejection fraction of 40% or less. Polypharmacy was present at baseline in 100% of patients. HF and PC medication counts increased in both arms, with no significant differences in counts by drug class at any time point between arms. CONCLUSIONS: In a trial of patients with advanced HF considered eligible for PC, polypharmacy was universal at baseline and increased during follow-up with no effect of the palliative intervention on medication counts relative to standard care.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

February 2022

Volume

28

Issue

2

Start / End Page

334 / 338

Location

United States

Related Subject Headings

  • Stroke Volume
  • Quality of Life
  • Polypharmacy
  • Palliative Care
  • Middle Aged
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged, 80 and over
 

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Granger, B. B., Tulsky, J. A., Kaufman, B. G., Clare, R. M., Anstrom, K., Mark, D. B., … Mentz, R. J. (2022). Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience. J Card Fail, 28(2), 334–338. https://doi.org/10.1016/j.cardfail.2021.08.021
Granger, Bradi B., James A. Tulsky, Brystana G. Kaufman, Robert M. Clare, Kevin Anstrom, Daniel B. Mark, Kimberly A. Johnson, et al. “Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience.J Card Fail 28, no. 2 (February 2022): 334–38. https://doi.org/10.1016/j.cardfail.2021.08.021.
Granger BB, Tulsky JA, Kaufman BG, Clare RM, Anstrom K, Mark DB, et al. Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience. J Card Fail. 2022 Feb;28(2):334–8.
Granger, Bradi B., et al. “Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience.J Card Fail, vol. 28, no. 2, Feb. 2022, pp. 334–38. Pubmed, doi:10.1016/j.cardfail.2021.08.021.
Granger BB, Tulsky JA, Kaufman BG, Clare RM, Anstrom K, Mark DB, Johnson KA, Patel CB, Fiuzat M, Steinhauser K, O’connor C, Rogers JG, Mentz RJ. Polypharmacy in Palliative Care for Advanced Heart Failure: The PAL-HF Experience. J Card Fail. 2022 Feb;28(2):334–338.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

February 2022

Volume

28

Issue

2

Start / End Page

334 / 338

Location

United States

Related Subject Headings

  • Stroke Volume
  • Quality of Life
  • Polypharmacy
  • Palliative Care
  • Middle Aged
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged, 80 and over