[Polytherapy and polypharmacy in elderly patients with chronic heart failure].

Population aging is associated with an increasing prevalence of chronic diseases (including chronic heart failure) and comorbidities (the presence of one or more diseases in addition to an index disease, potentially contributing to disability) which, in turn, expands the need for healthcare services. Therefore, the already elevated costs in the National Health Services are expected to rise further over the next decades, along with increasing aging of the population. This epidemiologic trend is responsible for the increasing occurrence of polytherapy (multiple medications prescribed to an individual patient) and polypharmacy (multiple medications not directly prescribed by a physician). Owing to often unpredictable interactions, polytherapy and polypharmacy are associated with higher risk of adverse drug reactions with increased mortality and hospitalizations that contribute to increase direct and indirect National Health Services costs. Physicians, patients and caregivers should be instructed in strategies aimed at reducing adverse drug reactions while maintaining optimal management of conditions that, such as chronic heart failure, are at high risk of death, functional impairment and deteriorated quality of life. Strategies consist of a variety of interventions, such as reducing inappropriate medication prescriptions and number of medications and doses taken, avoiding drugs with greater potential of interactions, and increasing patient adherence.