Heart Failure Medication Discontinuation Among Hospice Patients with Concomitant Heart Failure and Dementia.

BACKGROUND

Heart failure (HF) and Alzheimer's disease and related dementias (AD/ADRD) frequently co-occur, complicating medication management at the end of life.

METHODS

This secondary analysis included 1338 patients with HF and AD/ADRD across 12 hospices. HF was classified as a primary (n = 210) or secondary (n = 1128). HF-related medication use and discontinuation at hospice admission were characterized and compared by diagnosis primacy.

RESULTS

Prehospice use was highest for beta-blockers (44.0%), loop diuretics (32.4%), and renin-angiotensin-aldosterone system (RAAS) inhibitors (17.7%). Among patients with documented use, discontinuation was 91.2%-100% across medication classes, including beta-blockers (97.5%), loop diuretics (97.0%), and RAAS inhibitors (94.1%). Discontinuation did not differ by HF diagnostic primacy.

CONCLUSIONS

HF-related medication discontinuation was common at hospice admission among patients with HF and AD/ADRD, regardless of HF diagnostic primacy. Further research is needed to understand the clinical rationale and symptom outcomes associated with medication discontinuation in hospice.