Hyperpolypharmacy (≥10 medications) was significantly associated with worse long-term survival for MACE (p=0.004) and all-cause mortality (p=0.005) in advanced HFrEF patients undergoing CRT.
Cohort (n=147)
Does hyperpolypharmacy worsen clinical outcomes in patients with advanced HFrEF undergoing CRT?
Hyperpolypharmacy, particularly driven by noncardiovascular medications, is associated with worse long-term survival and increased MACE in patients with advanced HFrEF undergoing CRT.
valor p: p=0.004 for MACE, 0.005 for mortality
Abstract Background The prevalence rates of heart failure (HF) and hyperpolypharmacy have increased with the aging population. While a negative impact of hyperpolypharmacy on HF clinical outcomes has already been reported, the effects of hyperpolypharmacy on patients with advanced HF with reduced ejection fraction (HFrEF) undergoing cardiac resynchronization therapy (CRT) remain unclear. Methods We retrospectively evaluated data from 147 patients with advanced HFrEF who underwent CRT between March 2004 and June 2020. Patients were divided into nonpolypharmacy (<5 medications) and polypharmacy (≥5 medications) groups, as well as nonhyperpolypharmacy (<10 medications) and hyperpolypharmacy (≥10 medications) groups. Results The mean age of the study population was 70.6 ± 9.7 years, and 90 patients (67.2%) were male. The median number of medications used was 10 (interquartile range: 7–13, range: 2–24); Kaplan–Meier survival analysis revealed that the hyperpolypharmacy group had a significantly worse long‐term survival rate in terms of major adverse cardiovascular events (MACE; p = 0.004) and all‐cause mortality ( p = 0.005). Long‐term survival in terms of MACE and all‐cause mortality was not significantly different between the polypharmacy with cardiovascular medication and nonpolypharmacy with cardiovascular medication groups. By contrast, the polypharmacy with noncardiovascular medication group had a significantly worse long‐term survival rate in terms of MACE ( p = 0.006) and all‐cause mortality ( p = 0.003) than the nonpolypharmacy with noncardiovascular medication group. Conclusions Hyperpolypharmacy was significantly associated with adverse cardiovascular outcomes in patients with advanced HFrEF who underwent CRT. Noncardiovascular polypharmacy may underlie the harmful effects of hyperpolypharmacy.
Ono et al. (Fri,) conducted a cohort in Advanced heart failure with reduced ejection fraction (HFrEF) undergoing CRT (n=147). Hyperpolypharmacy (≥10 medications) vs. Nonhyperpolypharmacy (<10 medications) was evaluated on Major adverse cardiovascular events (MACE) and all-cause mortality (p=0.004 for MACE, 0.005 for mortality). Hyperpolypharmacy (≥10 medications) was significantly associated with worse long-term survival for MACE (p=0.004) and all-cause mortality (p=0.005) in advanced HFrEF patients undergoing CRT.