# Adverse Drug Events Associated with Optimizing Heart Failure Pharmacotherapy in Older Adults with Frailty: A Qualitative Study

## TL;DR

This study explores how adverse drug events affect older adults with heart failure and frailty, highlighting the need for better treatment strategies and healthcare coordination.

## Contribution

The study introduces a conceptual model based on consumer and healthcare professional perspectives on adverse drug events in heart failure treatment.

## Key findings

- Participants emphasized the need for support to maintain quality of life despite complex medical issues.
- Healthcare professionals generally believe the benefits of heart failure drugs outweigh the risks of adverse effects.
- Improved coordination among healthcare teams and better patient access to services were identified as key needs.

## Abstract

Adverse drug events (ADEs) from heart failure (HF) pharmacotherapy are common in older people with frailty, but evidence as to how to optimize HF pharmacotherapy is unclear. This qualitative study explores consumer and healthcare professional (HCP) perspectives on ADEs and adverse drug withdrawal effects (ADWEs) related to HF pharmacotherapy to inform key domains of a conceptual model.

A purposive and snowball sample of participants were contacted directly or recruited across Australia and New Zealand to participate in qualitative semistructured interviews and focus groups. Frailty was explained as a measure of cumulative deficits and consumers (caregivers or individuals aged ≥ 65 years with HF and frailty) and HCPs caring for older patients with HF and frailty were invited according to their self-perception or evaluation of frailty. General inductive analysis identified themes and a hypothesis-generating conceptual model.

Thirty-two participants were recruited (consumers [n = 4), cardiologists and other physicians [n = 9], nurses [n = 8], and pharmacists [n = 11]). Three main themes and 8 subthemes related to individual factors, medications, and access to healthcare services were identified. Consumers stated that they want support to maintain their quality of life but have complex medical issues. Most HCP participants perceived the benefits of HF pharmacotherapy to outweigh the risks of ADEs and are hesitant to deprescribe. Participants wanted improved coordination of multidisciplinary teams and patient access to healthcare services.

Perspectives unique to HF pharmacotherapy in older people with frailty characterize how the interplay of HF treatment, ADEs, and ADWEs contributes to individuals’ well-being. Future research is needed to further develop the conceptual model.