Co-morbidity and potential treatment conflicts in elderly heart failure patients: A retrospective, cross-sectional study of administrative claims data

Background: Co-morbidity of both cardiac and non-cardiac conditions common in the elderly with heart failure (HF) and can be associated with adverse clinical outcomes. Objectives: The aims of this study were to examine the prevalence of comorbidity and potential treatment conflicts that may result in adverse clinical outcomes in a large cohort of elderly HF patients. Methods: We conducted a cross-sectional study using administrative claims data (1 April to 31 July 2007) from the Department of Veterans Affairs, Australia, on all veterans aged <65 years with HF. Co-morbidities were defined using the pharmaceutical based co-morbidity index Rx-Risk-V. Potential treatment conflicts for patients with HF and co-morbid diseases were identified from Australian clinical guidelines or reference compendia and their prevalence in the data were determined. Results: A total of 6730 patients were included in the study, with a median of 6 co-morbid conditions (interquartile range [IQR] 47) and 11 (IQR 815) unique medicines. Almost the entire HF cohort (97.8%) were identified as having at least one co-morbid condition that may cause a potential treatment conflict, with 55% having three or more. The conditions identified as being of greatest concern, based on their prevalence and potential for treatment conflict, were chronic airways disease, depression, chronic pain/inflammatory disease, glaucoma, diabetes mellitus and diseases treatable with corticosteroids. Conclusions: Potential treatment conflicts are common in the highly comorbid population of elderly patients with HF, and may influence the therapeutic management of not only HF but all conditions present.