Major polypharmacy due to guideline-directed medical therapy was associated with improved survival in HFpEF (HR 0.62; 95% CI 0.52-0.75; p<0.001) and HFmrEF (HR 0.70; 95% CI 0.59-0.85; p=0.001).
Cross-Sectional (n=4,904)
Does the degree and type of polypharmacy affect mortality and ICU admissions in patients with chronic heart failure?
Guideline-directed polypharmacy improves survival across heart failure phenotypes, whereas excessive non-heart failure polypharmacy is associated with worse outcomes such as increased ICU admissions.
Estimación del efecto: HR 0.62 (95% CI 0.52-0.75)
valor p: p=<0.001
Abstract Background Polypharmacy is prevalent in patients with chronic heart failure (CHF), affecting 70-85% of this population. While necessary for managing comorbidities, its impact on heart failure outcomes remains unclear. Aim This study examines the effects of polypharmacy Phenogroups on mortality and ICU admissions across different heart failure phenotypes. Methods This prospective cross-sectional study included 4,904 CHF patients treated at a medical corporation, Qatar, from January 2018 to January 2022. Patients were categorized into polypharmacy groups: no polypharmacy (0–4 medications), major polypharmacy (5–8 medications), and excessive polypharmacy (≥9 medications). Heart failure phenotypes were defined based on ejection fraction (EF): reduced EF (HFrEF, 40%), mildly reduced EF (HFmrEF, 40–49%), and preserved EF (HFpEF, ≥50%). Primary outcome was all-cause mortality; secondary outcomes included ICU admissions. Results A total of 4904 patients with chronic heart failure were analyzed, with 51.7% having reduced ejection fraction (HFrEF), and 16.2%, and 32.0% having mildly reduced EF (HFmrEF), and preserved EF (HFpEF) respectively. Major polypharmacy due to guideline-directed medical therapy (GDMT), was associated with a significant improvement in survival. In patients with HFpEF, the hazard ratio (HR) for all-cause mortality was 0.62 (95% CI: 0.52-0.75, p0.001), while for HFmrEF, it was 0.70 (95% CI: 0.59-0.85, p=0.001). Conversely, excessive polypharmacy, especially involving non-heart failure medications, was linked to increased ICU admissions (odds ratio OR: 1.34, 95% CI: 1.10-1.62, p=0.02). Cox proportional hazards models demonstrated that excessive polypharmacy was associated with a hazard ratio of 0.11 (95% CI: 0.05-0.23, p0.001) for all-cause mortality when the medications were primarily heart failure specific. Conclusions In patients with chronic Heart failure, Guideline directed Polypharmacy, was associated with improved survival, particularly in HFpEF and HFmrEF phenotypes. However, non-heart failure-related polypharmacy is associated with worse outcomes, necessitating targeted interventions for this group of patients.
Aboughalia et al. (Sat,) conducted a cross-sectional in chronic heart failure (n=4,904). Polypharmacy phenogroups vs. No polypharmacy (0-4 medications) was evaluated on all-cause mortality (HR 0.62, 95% CI 0.52-0.75, p=<0.001). Major polypharmacy due to guideline-directed medical therapy was associated with improved survival in HFpEF (HR 0.62; 95% CI 0.52-0.75; p<0.001) and HFmrEF (HR 0.70; 95% CI 0.59-0.85; p=0.001).
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