Mike O'Meara's life runs on a tight schedule.
Every morning, after a glass of juice and breakfast, the 70-year-old picks up his medication from a blue labeled tray that his wife, Beth, prepared and gulps down 12 1/2 pills.
At noon, he swallows three more. Around dinnertime, three more. And before bed, he reaches for his nightstand drawer to grab his last doses of the day: 7 1/2 pills.
O'Meara has been diagnosed with diabetes, kidney problems and heart failure. He depends on 16 medicines — 26 pills a day — to manage his health. Taking a variety of pills is not unusual for older patients, but the American Heart Association has warned people with heart failure and their doctors that they need to monitor the variety of drugs because of the possibility of unintended consequences.
In the journal Circulation, the AHA said heart-failure patients take an average of nearly seven prescription medicines a day, and 40 percent of Medicare patients with heart failure have five or more other chronic diseases. According to the Centers for Disease Control and Prevention, roughly 5.7 million Americans live with heart failure, which is caused by the cardiac muscle's inability to pump blood efficiently enough to support the body's needs. Symptoms include shortness of breath, fatigue and swelling in the legs.
Among the most dangerous drugs for interaction, according to the AHA warning, are several commonly used to treat cancer, migraines, Parkinson's disease and mental-health problems.
Davy Cheng, a professor at Western Ontario University's medical school and an author of the statement, said he hoped it would serve as a "current up-to-date review" of the risks associated with medication given for heart failure.
More than 32 prescription medications were found to cause direct damage to the heart. For example, anthracyclines, a class of chemotherapy compounds frequently used to combat cancer, contain five agents known for causing irregular heart rhythms and inflammation. Researchers also linked ergotamine, a migraine medication, to heart-valve problems.
Commonly used over-the-counter drugs such as ibuprofen can contain high amounts of sodium and damage the heart by causing fluid buildup.
Heart failure is a progressive disease, which means medicines effective for a person today may stop working in a few months, said Gurusher Panjrath, an assistant professor of medicine at the George Washington University's medical school.
And because many people with heart failure are also dealing with other health conditions, keeping track of the drugs they are taking can be complicated. Many of these patients obtain pills from multiple doctors who seldom consult one another on what is being prescribed. And without oversight, the prescription cocktail can lead to deadly reactions.
"Heart failure is not an easy disease — like the flu — that you can forget about it, then it's gone," Cheng said. "Heart failure is a serious disease."
The AHA statement recommends ways for medical professionals to better understand their patients' drug regimens. It suggests that doctors regularly do a comprehensive review of the patient's medicines, including dosage and frequency, and consider verifying the information with the patient's pharmacy. It also recommends that physicians avoid prescribing new medication to alleviate side effects from other drugs.
The authors also advised doctors to carefully consider the risk and benefit of every medication before prescribing it to a patient.
Patient engagement is also important in bettering prescription drug management, said Robert Page, a professor of clinical pharmacy at the University of Colorado School of Pharmacy and the lead author of the study. He recommended that patients bring an accurate and complete list of medications to every doctor's visit. Individuals should also learn the risks of their medications and communicate frankly with their doctors.
"Patients need to be engaged now more than ever," Page said. "Medicine has become very complex."