2850. Burden of Difficult-to-Treat Antibiotic-Resistant (DTR) Gram-Negative Infections in the United States, 2012–2017

Abstract Background Difficult-to-treat resistance (DTR) is a metric for clinically relevant “pan-resistance” to available high-efficacy, low-toxicity antibiotic treatment options at any given time. Previous DTR prevalence estimates in Gram-negative (GN) bloodstream isolates from 2009 to 2014 have ranged between 1 and 1.5%. We sought to estimate the national burden of DTR GN isolates and more recent trends by region, site, and species. Methods Clinical cultures with GN isolates were identified from inpatient encounters in hospitals reporting at least one culture with susceptibility testing for a given month to Premier Healthcare Database or Cerner Health Facts Database from 2012 to 2017. DTR was defined as intermediate susceptibility or resistance to all tested carbapenems, other β-lactams, and fluoroquinolones, but not including agents introduced 2014 onwards. For each year, a raking procedure generated weights to extrapolate the sample estimate to match American Hospital Association distributions based on US census division, hospital bed capacity, teaching status, and urban designation. A weighted means survey procedure was used to extrapolate the sample estimate to obtain national DTR burden. Trends in DTR incidence were examined by using weighted multivariable logistic regression. Results Extrapolating from a 373-hospital sample, the estimated 2017 US inpatient burden of DTR isolates was 3,315 (1.3%) among sterile-site and 31,509 (1.7%) among all cultures, ranging from 0.5% to 3.3% in Mountain and New England regions respectively. P. aeruginosa was the most common species overall (37%), while A. baumannii was most common among sterile sites (31%). Between 2012 and 2017, there was no annual percent change in DTR incidence for sterile sites [OR 0.99 (0.93, 1.06)] but for all cultures it decreased 4.1% annually [OR 0.95 (0.91, 0.99)], including 9% annually for A. baumannii [OR 0.905 (0.860, 0.953)] and K. pneumonia [OR 0.903 (0.824, 0.991)], respectively. Conclusion The US inpatient burden of GN isolates displaying DTR is relatively low, varies by region, and has remained stable or declined slightly in recent years. Periodic inclusion of emerging antibiotics in the DTR classification will allow for a dynamic index between resistance and available agents. Disclosures All Authors: No reported Disclosures.

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2479. Trends and Regional Differences in Extended Spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2157 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S858-S859

Author(s):

Hannah Wolford ◽

Kelly M Hatfield ◽

Babatunde Olubajo ◽

Sujan Reddy ◽

John A Jernigan ◽

...

Keyword(s):

Regional Differences ◽

The United States ◽

Healthcare Database ◽

Size Category ◽

Antibiotic Resistant ◽

American Hospital ◽

American Hospital Association ◽

Extended Spectrum ◽

Urban Rural ◽

Us Census

Abstract Background Extended spectrum β-lactamase-producing Enterobacteriaceae (ESBLs) have been identified as a serious antibiotic-resistant threat. Studies have shown that ESBL infection rates were increasing through 2014. Our objective was to examine more recent ESBL trends and to evaluate differences across regions in the United States. Methods We measured the incidence of positive clinical cultures from inpatient encounters in a cohort of hospitals submitting data to the Premier Healthcare Database and Cerner Health Facts from 2012 through 2017. We included Escherichia coli and Klebsiella spp. cultures and defined ESBL as non-susceptibility to cefotaxime, ceftriaxone, ceftazidime, or cefepime. Cultures collected on days 1, 2, or 3 of hospitalization were considered community-onset (CO); cultures from day 4 or later were considered hospital onset (HO). We developed weights using a raking procedure to match the American Hospital Association distribution for acute care hospitals based on US census division, bed size category, teaching status, and urban/rural designation. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends and regional differences in ESBL rates. Results In 2017, the estimated rate of ESBLs was 40.3 per 10,000 discharges for CO and 6.4 per 10,000 discharges for HO; 86% of all ESBLs were CO. The percent that were ESBLs among all included cultures increased for CO (8.2% in 2012 to 11.6% in 2017) and HO (13.1 to 16.8%) cultures. From 2012 – 2017, adjusted ESBL rates increased for CO (7.9% annually, P < 0.0001), while HO rates did not change significantly over time (P = 0.39, Figure 1). We found significant regional differences in the rates of ESBL (P < 0.0001) across US census divisions in 2017 (Figure 2). Estimated rates for 2017 varied 5-fold from 15.3 ESBLs per 10,000 discharges in the Northwest Central to 82.4 ESBLs in the Mid-Atlantic. Conclusion We estimated a 40% increase in the rate of CO-ESBLs among hospitalized patients from 2012 to 2017, but no increase in HO rates. ESBL rates varied greatly by region of the country and are estimated as much as 5× higher in some areas. A better understanding of factors contributing to community transmission and regional variation is necessary in order to inform ESBL prevention efforts. Disclosures All authors: No reported disclosures.

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845. Trends and Regional Differences in Community-Onset Fluoroquinolone-Resistant E. coli in Hospitalized Adults in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1034 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S463-S463

Author(s):

Hannah Wolford ◽

James Baggs ◽

Kelly M Hatfield ◽

Babatunde Olubajo ◽

Leigh Ellyn Preston ◽

...

Keyword(s):

Regional Differences ◽

The United States ◽

Healthcare Database ◽

Size Category ◽

American Hospital ◽

American Hospital Association ◽

E Coli ◽

Empiric Treatment ◽

National Estimates ◽

Community Onset

Abstract Background Escherichia coli is a common cause of community-onset (CO) infections, including urinary tract and abdominal infections, and CO sepsis. Fluoroquinolones (FQ) are used in the empiric treatment of E. coli infections, but FQ-resistance may limit their effectiveness. We examined trends and regional differences in FQ-resistant E. coli clinical cultures among hospitalized adult patients in the U.S. Methods We measured the incidence of E. coli clinical cultures among hospitalized adults in a cohort of hospitals in the Premier Healthcare Database and Cerner Health Facts from 2012 through 2017. FQ resistance was defined as resistance to ciprofloxacin, levofloxacin, or moxifloxacin. Only cultures collected prior to day 4 of hospitalization, defined as CO, were considered. We extrapolated national estimates using a raking procedure to generate weighted adjustments matching the American Hospital Association distribution for U.S. acute care hospitals. Weights were based on U.S. census division, bed size category, teaching status, and urban/rural designation. We used a weighted means survey procedure to calculate national estimates and weighted multivariable logistic regression to examine trends and regional differences. Results In 2017, we estimated 949,393 CO E. coli infections with FQ susceptibility testing; 312,304 (33%) were due to E. coli resistant to FQ. Of FQ-resistant E. coli isolates, 76% were isolated from urine. We did not observe a significant trend in FQ-resistant E. coli from 2012 to 2017 (p = 0.85). Percent FQ-resistant varied significantly by region (p < 0.0001) with an estimated range of 19% (Mountain) to 42% (Southeast Central) in 2017. We also found variability by hospital (2017 Q1: 26% and Q3: 39%). FQ-resistance rates were higher in urine (36%: 95% CI 34-38%) than blood isolates (27%: 95% CI 26-29%) and higher for males (40%: 95% CI 38-42%) than females (33%: 95% CI 31-35%). Conclusion FQ-resistance is common in CO E. coli infections with significant variability by region and hospital. Empiric FQ treatment for infectious syndromes commonly caused by E. coli may need to be reconsidered. Clinicians should consult with local antibiograms and antibiotic stewardship programs to determine the most appropriate empiric treatment of E. coli infections in hospitalized adults. Disclosures All Authors: No reported disclosures

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Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

BMC Psychiatry ◽

10.1186/s12888-021-03180-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhong Li ◽

Sayward E. Harrison ◽

Xiaoming Li ◽

Peiyin Hung

Keyword(s):

Continuity Of Care ◽

Psychiatric Care ◽

The United States ◽

Psychiatric Services ◽

Linear Regression Models ◽

Cross Sectional ◽

Promising Alternative ◽

American Hospital ◽

American Hospital Association ◽

Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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Hospital Care in the United States, Commission on Hospital Care, New York, The Commonwealth Fund

PEDIATRICS ◽

10.1542/peds.6.1.172 ◽

1950 ◽

Vol 6 (1) ◽

pp. 172-172

Keyword(s):

New York ◽

Hospital Care ◽

The United States ◽

Hospital Services ◽

Source Book ◽

American Hospital ◽

American Hospital Association ◽

Commonwealth Fund ◽

Wide Range ◽

Present Pattern

Many individuals and organizations have had a part in the making of this book. They have described influences and forces whose interaction has resulted in the present pattern of our hospital services, and documented their interpretations. The result is a source book of basic information which should be valuable for all students of hospital problems. The Commission was appointed by the American Hospital Association, and chosen to represent a wide range of those providing hospital, health and welfare services, as well as the consuming public.

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Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States

Circulation ◽

10.1161/circ.138.suppl_2.23 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Mathias J Holmberg ◽

Catherine Ross ◽

Paul S Chan ◽

Jordan Duval-Arnould ◽

Anne V Grossestreuer ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

The United States ◽

Annual Incidence ◽

Adult Patients ◽

Negative Binomial Regression Model ◽

American Hospital ◽

American Hospital Association ◽

Average Annual Incidence ◽

Hospital Cardiac Arrest

Introduction: Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States. Methods: Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (>18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events. Results: There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases. Conclusions: Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.

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Are nurses still practicing coronary precautions? A national survey of nursing care of acute myocardial infarction patients

American Journal of Critical Care ◽

10.4037/ajcc1996.5.2.91 ◽

1996 ◽

Vol 5 (2) ◽

pp. 91-98 ◽

Cited By ~ 3

Author(s):

B Riegel ◽

T Thomason ◽

B Carlson ◽

I Gocka

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Temperature Measurement ◽

Rectal Temperature ◽

Valsalva Maneuver ◽

The United States ◽

American Hospital ◽

American Hospital Association ◽

Survey Techniques ◽

The 1960S

BACKGROUND: Coronary precautions were common when coronary care units were instituted in the 1960s. However, research has failed to provide evidence of the validity of most of these restrictions. Only the avoidance of the Valsalva maneuver is clearly indicated as a universal precaution in patients who have experienced acute myocardial infarction. OBJECTIVES: To determine if nurses continue to restrict iced and hot fluids, caffeine, rectal temperature measurement, and vigorous back rubs, and to feed and mandate bedrest for acute myocardial infarction patients. METHODS: Survey techniques were used to describe practice patterns of nurses working in hospitals across the United States. Two sampling methods were used to access a random sample. The survey was mailed to members of the American Association of Critical-Care Nurses and nonmembers working in a hospital accredited by the American Hospital Association and with an intensive care unit. RESULTS: Of the 2549 mailed surveys, 882 were returned with usable data (34.8% response rate). Iced (28.1%) and hot (8.7%) fluids continued to be restricted by nurses. Most (85.6%) restricted stimulant beverages such as coffee. Rectal temperature measurement was avoided by 55.7%, and only 73.3% taught avoidance of the Valsalva maneuver. In terms of rest, 15.6% reported avoiding vigorous back rubs, 8.4% still fed patients, and 33.8% offered bedpans to pain-free patients on the first day after admission. A complete bedbath was offered by 19.8% of nurses to stable, pain-free patients even a day after admission. CONCLUSIONS: The data supporting liberalization of coronary precautions have not been adequately disseminated.

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517. Treatment Patterns of Hospitalized Adults with Infections Due to Carbapenem Non-Susceptible Gram-Negative Organisms in a Large Electronic Health Record Database in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.586 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S249-S249

Author(s):

Tanya Burton ◽

Amy Anderson ◽

Jerry Seare ◽

Ryan J Dillon ◽

Eilish McCann

Keyword(s):

Pseudomonas Aeruginosa ◽

Electronic Health Record ◽

Infection Type ◽

Treatment Options ◽

Complicated Urinary Tract Infection ◽

The United States ◽

Treatment Patterns ◽

Health Record ◽

Gram Negative ◽

Electronic Health

Abstract Background Infections caused by carbapenem non-susceptible (C-NS) Gram-negative (GN) organisms pose a major threat, due in part to limited treatment options. The aim of this study was to assess treatment patterns for these infections in a large US electronic health record database. Methods A retrospective cohort study of hospitalized adults with complicated intra-abdominal infection (cIAI), complicated urinary tract infection (cUTI), bacterial pneumonia (BP), or bacteremia (BAC) due to C-NS (resistant/intermediate susceptibility to carbapenem) GN organisms from January 2013 to March 2018. Patients with inherently C-NS organisms (e.g., Pseudomonas aeruginosa to ertapenem) were only included if resistance to another carbapenem was identified. The index date was the date of first C-NS culture in a qualifying hospitalization (±3 days from admission/discharge). Clinical characteristics and administered treatments were assessed from admission to discharge with variables summarized descriptively and stratified by infection type. Results 7,702 patients met inclusion criteria: 31% cUTI ± BAC, 24% BP ± BAC, 21% cUTI + BP ± BAC, 17% cIAI ± BAC, cUTI, or BP, 7% BAC only. The median age was 66 years, ranging from 60 (BAC) to 69 (cUTI) years; male, 57%. The most common pathogens were Pseudomonas aeruginosa (64%) and Klebsiella pneumoniae (15%). Antibiotics were administered to the majority of patients (87%); of which, 79% received combination therapy (median classes: 3, maximum: 7), the remainder received monotherapy. For antibiotic-treated patients, 93% initiated an antibiotic before the non-susceptibility status of the underlying organism was known. The most common classes given during the index hospitalization were: penicillin (49%), fluoroquinolone (44%), carbapenem (40%), cephalosporin (39%), aminoglycoside (28%) (by infection type, Figure 1). Eleven percent of patients received colistin/polymyxin B. Conclusion Varied antibiotic use was observed in this cohort, with carbapenems frequently detected despite the C-NS nature of the underlying GN organisms. The use of antibiotics to which organisms are non-susceptible could lead to poor health outcomes, supporting the need for new targeted therapies to treat C-NS infections. Disclosures All authors: No reported disclosures.

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545. Incidence of Carbapenem Non-Susceptible Acinetobacter spp. and Carbapenem-Resistant Pseudomonas aeruginosa Clinical Cultures among Patients in US Acute Care Hospitals, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.614 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S260-S260

Author(s):

Sophia Kazakova ◽

James Baggs ◽

Hannah Wolford ◽

Babatunde Olubajo ◽

Kelly M Hatfield ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Acute Care ◽

Statistical Significance ◽

Acute Care Hospitals ◽

Healthcare Database ◽

American Hospital ◽

American Hospital Association ◽

Carbapenem Resistant ◽

Effective Interventions ◽

Acinetobacter Spp

Abstract Background Carbapenem-nonsusceptible Acinetobacter spp. (CNAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are recognized causes of severe and difficult to treat healthcare-associated infections. This study estimated and compared the incidence of CNAB and CRPA among patients admitted to US acute care hospitals in 2012–2017. Methods We measured the incidence of positive clinical cultures from inpatient encounters in a cohort of over 300 hospitals submitting data to the Premier Healthcare Database and Cerner Health Facts in 2012–2017. We included clinical cultures from any body site yielding Acinetobacter spp./P. aeruginosa non-susceptible/resistant to imipenem, meropenem, or doripenem. Cultures collected on days 1–3 of hospitalization were considered community-onset (CO) and cultures from later were hospital-onset (HO). Duplicate isolates identified within 14 days of an incident culture and surveillance cultures were excluded. For each year, a raking procedure generated weights to extrapolate the sample estimate to match the American Hospital Association distributions based on US census division, hospital bed capacity, teaching status, and urban designation. We compared estimated rates in 2017 vs. 2012 using weighted multivariable logistic regression adjusting for hospital characteristics and hospital-level clustering. Results In 2017, the estimated rates of HO and CO CNAB rates were 0.77 and 1.39/10,000 discharges, and HO and CO CRPA rates were 3.14 and 6.57, respectively. Compared with 2017, rates of HO CNAB decreased 49% (Odds Ratio (OR) 0.51; 95% CI: 0.34–0.75) and rates of CO CNAB decreased 29% (OR 0.71; 95% CI: 0.54–0.92). For CRPA, the incidence of HO decreased (OR 0.66; CI: 0.49–0.88) with no change in CO rates (OR 0.93; CI: 0.79–1.11). Assessment of cultures from sterile sites alone showed similar results, but they did not reach statistical significance, Figure 1. Conclusion We estimate significant national decreases in the rates of HO and CO CNAB, and HO CRPA. Risk factors and effective interventions to reduce CO CRPA might differ from CNAB and HO CRPA. Additional prevention strategies are needed to address CO CRPA. Disclosures All authors: No reported disclosures.

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STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL

Innovation in Aging ◽

10.1093/geroni/igz038.3054 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S829-S829

Author(s):

Teri Kennedy

Keyword(s):

Older Adults ◽

Health System ◽

Baby Boomers ◽

Health Systems ◽

Adult Population ◽

The United States ◽

Essential Elements ◽

Conceptual Approach ◽

American Hospital ◽

American Hospital Association

Abstract This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.

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Polypharmacy in Older Adults Hospitalized for Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.120.006977 ◽

2020 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Ozan Unlu ◽

Emily B. Levitan ◽

Evgeniya Reshetnyak ◽

Jerard Kneifati-Hayek ◽

Ivan Diaz ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Racial Differences ◽

The United States ◽

Negative Effects ◽

Real World Data ◽

American Hospital ◽

American Hospital Association ◽

Annual Survey ◽

Regards Study

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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