Managing Therapeutic Competition in Patients with Heart Failure, Lower Urinary Tract Symptoms and Incontinence
2014 (English)In: Drugs & Aging, ISSN 1170-229X, Vol. 31, no 2, 93-101 p.Article in journal (Refereed) Published
Up to 50 % of heart failure patients suffer from lower urinary tract symptoms. Urinary incontinence has been associated with worse functional status in patients with heart failure, occurring three times more frequently in patients with New York Heart Association Class III and IV symptoms compared with those with milder disease. The association between heart failure and urinary symptoms may be directly attributable to worsening heart failure pathophysiology; however, medications used to treat heart failure may also indirectly provoke or exacerbate urinary symptoms. This type of drug-disease interaction, in which the treatment for heart failure precipitates incontinence, and removal of medications to relieve incontinence worsens heart failure, can be termed therapeutic competition. The mechanisms by which heart failure medication such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers aggravate lower urinary tract symptoms are discussed. Initiation of a prescribing cascade, whereby antimuscarinic agents or beta 3-agonists are added to treat symptoms of urinary urgency and incontinence, is best avoided. Recommendations and practical tips are provided that outline more judicious management of heart failure patients with lower urinary tract symptoms. Compelling strategies to improve urinary outcomes include titrating diuretics, switching ACE inhibitors, treating lower urinary tract infections, appropriate fluid management, daily weighing, and uptake of pelvic floor muscle exercises.
Place, publisher, year, edition, pages
2014. Vol. 31, no 2, 93-101 p.
Gerontology, specializing in Medical and Health Sciences Geriatrics Pharmacology and Toxicology
IdentifiersURN: urn:nbn:se:su:diva-101740DOI: 10.1007/s40266-013-0145-1ISI: 000331076900002OAI: oai:DiVA.org:su-101740DiVA: diva2:705716
FunderSwedish Research Council
Other funders: Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging from the Faculty of Pharmacy at the Universite de Montreal; Fonds de Recherche du Quebec-Sante 2014-03-172014-03-142014-03-17Bibliographically approved