When It Ain't Broke But Still Needs Some Fixin

Most hospitalized patients with heart failure aged ≥65 years have polypharmacy, and most will be discharged with >10 medications.2,3 The potential adverse effects of polypharmacy, including falls and cognitive decrease, remain concerning for ongoing morbidity and mortality. Reduced reimbursements for cardiovascular services have certainly raised demands to see more patients in shorter time intervals.4,5 Limited time means less proper trainee education, including fewer discussions on the risks and benefits of discontinuing medications with patients and caregivers (reported by 21% of survey respondents). Undoubtedly, meeting the relative value unit needs of business interferes with proper trainee education and optimal medical care.