1
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Grauer A, Kneifati-Hayek J, Reuland B, Applebaum JR, Adelman JS, Green RA, Lisak-Phillips J, Liebovitz D, Byrd TF, Kansal P, Wilkes C, Falck S, Larson C, Shilka J, VanDril E, Schiff GD, Galanter WL, Lambert BL. Indication alerts to improve problem list documentation. J Am Med Inform Assoc 2021; 29:909-917. [PMID: 34957491 PMCID: PMC9006708 DOI: 10.1093/jamia/ocab285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Problem lists represent an integral component of high-quality care. However, they are often inaccurate and incomplete. We studied the effects of alerts integrated into the inpatient and outpatient computerized provider order entry systems to assist in adding problems to the problem list when ordering medications that lacked a corresponding indication. METHODS We analyzed medication orders from 2 healthcare systems that used an innovative indication alert. We collected data at site 1 between December 2018 and January 2020, and at site 2 between May and June 2021. We reviewed random samples of 100 charts from each site that had problems added in response to the alert. Outcomes were: (1) alert yield, the proportion of triggered alerts that led to a problem added and (2) problem accuracy, the proportion of problems placed that were accurate by chart review. RESULTS Alerts were triggered 131 134, and 6178 times at sites 1 and 2, respectively, resulting in a yield of 109 055 (83.2%) and 2874 (46.5%), P< .001. Orders were abandoned, for example, not completed, in 11.1% and 9.6% of orders, respectively, P<.001. Of the 100 sample problems, reviewers deemed 88% ± 3% and 91% ± 3% to be accurate, respectively, P = .65, with a mean of 90% ± 2%. CONCLUSIONS Indication alerts triggered by medication orders initiated in the absence of a justifying diagnosis were useful for populating problem lists, with yields of 83.2% and 46.5% at 2 healthcare systems. Problems were placed with a reasonable level of accuracy, with 90% ± 2% of problems deemed accurate based on chart review.
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Affiliation(s)
- Anne Grauer
- Corresponding Author: Anne Grauer, MD, 630 West 168th street, PH 9E-117, New York City, NY 10032, USA;
| | - Jerard Kneifati-Hayek
- Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Brian Reuland
- Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Jo R Applebaum
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York City, New York, USA
| | - Jason S Adelman
- Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA,Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York City, New York, USA
| | - Robert A Green
- Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA,Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York City, New York, USA
| | - Jeanette Lisak-Phillips
- Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - David Liebovitz
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas F Byrd
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Preeti Kansal
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Cheryl Wilkes
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Suzanne Falck
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Connie Larson
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA
| | - John Shilka
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elizabeth VanDril
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gordon D Schiff
- Brigham and Women’s Hospital Center for Patient Safety Research, Harvard Medical School Center for Primary Care, Boston, Massachusetts, USA
| | - William L Galanter
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA,Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA,Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bruce L Lambert
- Center for Communication and Health, Department of Communication Studies, Northwestern University, Chicago, Illinois, USA
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2
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Kneifati-Hayek J, Huebner J, Grauer A, Applebaum JR, Albanese C, Adelman JS. A medication frequency error resulting in hypermagnesemia in a patient with kidney failure. Nephrology (Carlton) 2021; 27:541-542. [PMID: 34841603 DOI: 10.1111/nep.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jerard Kneifati-Hayek
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jack Huebner
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Anne Grauer
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jo R Applebaum
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Craig Albanese
- Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jason S Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York, USA
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3
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Unlu O, Levitan EB, Reshetnyak E, Kneifati-Hayek J, Diaz I, Archambault A, Chen L, Hanlon JT, Maurer MS, Safford MM, Lachs MS, Goyal P. Polypharmacy in Older Adults Hospitalized for Heart Failure. Circ Heart Fail 2020; 13:e006977. [PMID: 33045844 DOI: 10.1161/circheartfailure.120.006977] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). METHODS We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare's Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. RESULTS The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. CONCLUSIONS Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.
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Affiliation(s)
- Ozan Unlu
- Department of Medicine (O.U.), Weill Cornell Medicine, New York, NY
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham (E.B.L., L.C.)
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine/Department of Medicine (E.R., A.A., M.M.S., P.G.), Weill Cornell Medicine, New York, NY
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine (J.K.-H.), Columbia University Medical Center, New York, NY
| | - Ivan Diaz
- Department of Healthcare Policy and Research (I.D.), Weill Cornell Medicine, New York, NY
| | - Alexi Archambault
- Division of General Internal Medicine/Department of Medicine (E.R., A.A., M.M.S., P.G.), Weill Cornell Medicine, New York, NY
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham (E.B.L., L.C.)
| | - Joseph T Hanlon
- Department of Medicine, University of Pittsburgh, PA (J.T.H.)
| | - Mathew S Maurer
- Division of Cardiology (M.S.M.), Columbia University Medical Center, New York, NY
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine (E.R., A.A., M.M.S., P.G.), Weill Cornell Medicine, New York, NY
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine (M.L.), Weill Cornell Medicine, New York, NY
| | - Parag Goyal
- Division of General Internal Medicine/Department of Medicine (E.R., A.A., M.M.S., P.G.), Weill Cornell Medicine, New York, NY.,Division of Cardiology/Department of Medicine (P.G.), Weill Cornell Medicine, New York, NY
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Goyal P, Kneifati-Hayek J, Archambault A, Mehta K, Levitan EB, Chen L, Diaz I, Hollenberg J, Hanlon JT, Lachs MS, Maurer MS, Safford MM. Reply. JACC: Heart Failure 2020; 8:247-248. [DOI: 10.1016/j.jchf.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 10/24/2022]
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5
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Goffman D, Kern-Goldberger A, Kneifati-Hayek J, Fernandes Y, Applebaum J, Adelman J. 46: Wrong patient orders in obstetrics: An unrecognized patient safety risk. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Southern WN, Applebaum JR, Salmasian H, Kneifati-Hayek J, Carter EJ, Sumner JA, Adelman JS. Clinician Experience of Electronic Health Record Configurations Displaying 1 vs 4 Records at a Time. JAMA Intern Med 2019; 179:1723-1725. [PMID: 31524923 PMCID: PMC6749535 DOI: 10.1001/jamainternmed.2019.3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 11/14/2022]
Affiliation(s)
- William N. Southern
- Division of Hospital Medicine, Albert Einstein College of Medicine, Bronx, New York
- Montefiore Medical Center, Bronx, New York
| | | | - Hojjat Salmasian
- Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jerard Kneifati-Hayek
- NewYork-Presbyterian Hospital, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Eileen J. Carter
- NewYork-Presbyterian Hospital, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | | | - Jason S. Adelman
- NewYork-Presbyterian Hospital, New York, New York
- Columbia University Irving Medical Center, New York, New York
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Goyal P, Kneifati-Hayek J, Archambault A, Mehta K, Levitan EB, Chen L, Diaz I, Hollenberg J, Hanlon JT, Lachs MS, Maurer MS, Safford MM. Prescribing Patterns of Heart Failure-Exacerbating Medications Following a Heart Failure Hospitalization. JACC Heart Fail 2019; 8:25-34. [PMID: 31706836 PMCID: PMC7521627 DOI: 10.1016/j.jchf.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to describe the patterns of heart failure (HF)-exacerbating medications used among older adults hospitalized for HF and to examine determinants of HF-exacerbating medication use. BACKGROUND HF-exacerbating medications can potentially contribute to adverse outcomes and could represent an important target for future strategies to improve post-hospitalization outcomes. METHODS Medicare beneficiaries ≥65 years of age with an adjudicated HF hospitalization between 2003 and 2014 were derived from the geographically diverse REGARDS (Reasons for Geographic and Racial Difference in Stroke) cohort study. Major HF-exacerbating medications, defined as those listed on the 2016 American Heart Association Scientific Statement listing medications that can precipitate or induce HF, were examined. Patterns of prescribing medications at hospital admission and at discharge were examined, as well as changes that occurred between admission and discharge; and a multivariable logistic regression analysis was conducted to identify determinants of harmful prescribing practices following HF hospitalization (defined as either the continuation of an HF-exacerbating medications or an increase in the number of HF-exacerbating medications between hospital admission and discharge). RESULTS Among 558 unique individuals, 18% experienced a decrease in the number of HF-exacerbating medications between admission and discharge, 19% remained at the same number, and 12% experienced an increase. Multivariable logistic regression analysis revealed that diabetes (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18 to 2.75]) and small hospital size (OR: 1.93; 95% CI: 1.18 to 3.16) were the strongest, independently associated determinants of harmful prescribing practices. CONCLUSIONS HF-exacerbating medication regimens are often continued or started following an HF hospitalization. These findings highlight an ongoing need to develop strategies to improve safe prescribing practices in this vulnerable population.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology, Weill Cornell Medicine, New York, New York; Division of General Internal Medicine, Weill Cornell Medicine, New York, New York.
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine, Columbia University Medical Center, New York, New York
| | - Alexi Archambault
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Krisha Mehta
- School of Medicine at Stony Brook University, Stony Brook, New York
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ivan Diaz
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - James Hollenberg
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Joseph T Hanlon
- Department of Medicine, University of Pittsburgh; Pittsburgh, Pennsylvania
| | - Mark S Lachs
- Division of Geriatrics, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
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8
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Yum B, Archambault A, Levitan EB, Dharamdasani T, Kneifati-Hayek J, Hanlon JT, Diaz I, Maurer MS, Lachs MS, Safford MM, Goyal P. Indications for β-Blocker Prescriptions in Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc 2019; 67:1461-1466. [PMID: 31095736 DOI: 10.1111/jgs.15977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To better understand indications for β-blocker (BB) prescriptions among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF). DESIGN/SETTING Retrospective observational study of hospitalizations derived from the geographically diverse Reasons for Geographic and Racial Differences in Stroke cohort. PARTICIPANTS We examined Medicare beneficiaries aged 65 years or older with an expert-adjudicated hospitalization for HFpEF (left ventricular ejection fraction = 50% or greater). MEASUREMENTS Discharge medications and indications for BBs were abstracted from medical records. RESULTS Of 306 hospitalizations for HFpEF, BBs were prescribed at discharge in 68%. Among hospitalizations resulting in BB prescriptions, 60% had a compelling indication for BB-44% had arrhythmias, and 29% had myocardial infarction (MI) history. Among the 40% with neither indication, 57% had coronary artery disease (CAD) without MI and 38% had hypertension alone (without arrhythmia, MI, or CAD), both clinical scenarios with little supportive evidence of benefit of BBs. Among hospitalizations resulting in BB prescription at discharge, 69% had geriatric conditions (functional limitation, cognitive impairment, hypoalbuminemia, or history of falls). There were no significant differences in the prevalence of geriatric conditions between hospitalizations of individuals with compelling indications for BBs and hospitalizations of individuals with noncompelling indications. CONCLUSIONS BBs are commonly prescribed following a hospitalization for HFpEF, even in the absence of compelling indications. This occurs even for hospitalizations of individuals with geriatric conditions, a subpopulation who may be at elevated risk for experiencing harm from BBs.
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Affiliation(s)
- Brian Yum
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Emily B Levitan
- Department of Epidemiology, University of Alabama-Birmingham, Birmingham, Alabama
| | | | - Jerard Kneifati-Hayek
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph T Hanlon
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ivan Diaz
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mark S Lachs
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
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9
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Kennel PJ, Kneifati-Hayek J, Bryan J, Banerjee S, Sobol I, Lachs MS, Safford MM, Goyal P. Prevalence and determinants of Hyperpolypharmacy in adults with heart failure: an observational study from the National Health and Nutrition Examination Survey (NHANES). BMC Cardiovasc Disord 2019; 19:76. [PMID: 30935411 PMCID: PMC6444677 DOI: 10.1186/s12872-019-1058-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF. Methods We studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003–2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF. Results The prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy. Conclusion Hyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
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Affiliation(s)
- Peter J Kennel
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Joanna Bryan
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Samprit Banerjee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Irina Sobol
- Division of Cardiology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Parag Goyal
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA. .,Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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10
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Kneifati-Hayek J, Archambault A, Mehta K, Chen L, Diaz I, Hanlon J, Levitan E, Lachs M, Maurer M, Safford M, Goyal P. HEART FAILURE-EXACERBATING MEDICATION USE IS COMMON BOTH BEFORE AND AFTER A HEART FAILURE HOSPITALIZATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Yum B, Archambault A, Kneifati-Hayek J, Chen L, Levitan E, Lachs M, Maurer M, Safford M, Goyal P. PATTERN OF β-BLOCKER USE FOLLOWING HOSPITALIZATION OF OLDER ADULTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF) FROM THE REGARDS STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Goyal P, Bryan J, Kneifati-Hayek J, Sterling MR, Banerjee S, Maurer MS, Lachs MS, Safford MM. Association Between Functional Impairment and Medication Burden in Adults with Heart Failure. J Am Geriatr Soc 2018; 67:284-291. [PMID: 30488944 DOI: 10.1111/jgs.15654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether the number of medications taken by adults with heart failure (HF) and impairment in activities of daily living (ADL)-a subpopulation in whom the risks of a high medication burden may outweigh the benefits-differs from the number taken by those without impairment in ADLs. DESIGN Cross-sectional. SETTING National Health and Nutrition Examination Survey (NHANES; 2003-2014), a cross-sectional survey that produces national estimates of adults in the United States. PARTICIPANTS Adults aged 50 and older (mean 70) with self-reported HF (N= 947; representing 4.6 million adults with HF in the United States. MEASURMENTS We assessed ADL impairment and medication count based on self-report. ADL impairment was defined as having difficulty with or being unable to dress, feed oneself, or get in and out of bed. To determine the independent association between ADL impairment and medication count, we performed sequential Poisson multivariable regression analyses. All analyses were cross-sectional in nature and accounted for the complex survey design of NHANES. RESULTS Mean medication count was 7.2, and 74% of participants were taking 5 or more medications (polypharmacy). In a multivariable model, ADL impairment was not independently associated with medication count. These findings were similar for those with 3 or more hospitalizations in the prior year, declining health status, and cognitive impairment. CONCLUSION After adjusting for confounders including comorbidity, we found that adults with HF and ADL impairment take as many medications as those without ADL impairment. This suggests that providers may not sufficiently consider functional impairment when prescribing medications to adults with HF and thus may unnecessarily expose individuals to risk of adverse outcomes. J Am Geriatr Soc 67:284-291, 2019.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Bryan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York
| | - Mark S Lachs
- Division of Geriatrics, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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13
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Kennel PJ, Kneifati-Hayek J, Bryan J, Mehta K, Banerjee S, Sobol I, Safford M, Goyal P. Prevalence and Determinants of Hyperpolypharmacy in Adults with Heart Failure. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kotbi N, Singh A, Kneifati-Hayek J, Odom A, Alexopoulos G. Citalopram in agitated and delusional demented patients who failed treatment with antipsychotic agents. J Neuropsychiatry Clin Neurosci 2014; 26:E62. [PMID: 24763800 DOI: 10.1176/appi.neuropsych.13060122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Haq SA, Tavakol M, Silber S, Bernstein L, Kneifati-Hayek J, Schleffer M, Banko LT, Heitner JF, Sacchi TJ, Puma JA. Enhancing the Diagnostic Performance of Troponins in the Acute Care Setting. J Emerg Med 2011; 40:367-73. [DOI: 10.1016/j.jemermed.2008.02.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 02/20/2008] [Accepted: 02/27/2008] [Indexed: 10/21/2022]
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