Taking too many medicines for heart failure seems to be bad for your health.
When we try to increase the amount of medication for heart failure in patients, many patients say that their symptoms are getting better, so they don't want to increase the type or amount of medication they are taking. Drug therapy is essential for the management of heart failure, especially when the contractile force of the heart is worsening. It is necessary to take four types of heart failure drugs orally and increase the dose sufficiently to prevent heart failure readmissions and extend life prognosis (lifespan).1. However, in outpatient settings, we often hear patients say, ``I don't want to increase the number of drugs or increase the dosage of my current medication.'' I didn't realize this until now, but one day when I asked someone, ``Why don't you want to increase the number of medicines you take or increase the dosage?'' I was surprised to hear that someone answered, ``Because taking too many medicines for heart failure seems to be bad for your health.'' As a cardiologist, this was a blind spot.
Types of heart failure drugs
Heart failure is a disease caused by heart failure that causes shortness of breath and swelling, which gradually worsens and shortens life. Currently, the typical therapeutic drugs that have the effect of improving prognosis include (1) angiotensin-converting enzyme inhibitors, (2) beta blockers, (3) SGLT2 inhibitors, and (4) mineralocorticoid receptor antagonists. These four types are referred to as the Fantastic four. It is said that taking all of these drugs orally has a better prognosis for patients with heart failure due to decreased cardiac contractility.1. Therefore, even if the patient's symptoms are stable on an outpatient basis, we will suggest adding or increasing the dose of these drugs as necessary.
Doctor's laziness (Clinical Inertia)
As I mentioned earlier, even if you try to increase the amount of medication based on guidelines (treatment guidelines) and scientific evidence, it is ``laborious'' to suggest dosage adjustments to patients, which is not a good expression. If this happens, both the patient and the doctor may feel comfortable telling the patient to continue with the current medication, and treatment may not be strengthened. This is called clinical inertia, and it is a major problem that can lead to inadequate or delayed treatment.2。
Summary
Increasing the number of drugs required is not necessarily bad for health, but in treating heart failure due to decreased cardiac function, it is more effective to take the necessary and sufficient drugs orally.
References
- Bauersachs, J. (2021). Heart failure drug treatment: the fantastic four [Review of Heart failure drug treatment: the fantastic four]. European Heart Journal, 42(6), 681–683.
- Verhestraeten, C., Heggermont, W. A., & Maris, M. (2021). Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Failure Reviews, 26(6), 1359–1370.