(P-244) Polypharmacy Among Older Individuals with Heart Failure: Trends Between 2000 and 2017 in the Province of Quebec, Canada

Background: Pharmacological management of heart failure may result in polypharmacy, but there is scarce population-based data that portrays the use of medications over time.

Objectives: To describe the trends in polypharmacy and medication use among older individuals with heart failure in the province of Quebec, Canada, between 2000 and 2017.

Methods: We conducted a population-based study using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) to identify all individuals ≥65 years with a validated diagnosis of heart failure. Three levels of polypharmacy were evaluated: ≥10, ≥15, ≥20 different medications per year. Medication use was ascertained by the presence of at least one claim in each year. We calculated the proportions of individuals exposed to polypharmacy and appropriate/inappropriate medications each year and tested age- and sex-standardized trends using Poisson regression models.

Results: The proportion of individuals with hearth failure using ≥10, ≥15, ≥20 different medications increased from 62.2% (95% CI: 60.2-63.7), 30.6% (29.4-31.3) and 12.2% (11.7-12.8) in 2000 to 71.9% (70.3-73.5), 43.9% (42.8-44.9) and 22.7% (22.1-23.2) in 2017, respectively. The combination β-blocker + angiotensin converting enzyme inhibitor (ACEI) /angiotensin II receptor blocker (ARB) was used by 30.4% (29.6-31.2) of individuals in 2000 and 45.5% (44.7-46.2) in 2017. The proportion of ACEI/ARB users increased from 65.8% (64.6-67.0) in 2000 to 71.8% (70.7-72.9) in 2008, then decreased to 62.1% (61.3-63.0) in 2017. The use of all potentially inappropriate medications decreased over the period.

Conclusions: This population-based study confirms that polypharmacy is significant among older adults with heart failure. There is a need to assess the appropriateness of medication use, especially considering the reduction in ACEI/ARB claims.