Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT‐HF registry

Aims Polypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline‐directed HF medications provide therapeutic benefits, non‐HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT‐HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1‐year outcome associations of non‐HF polypharmacy. Methods and results Medication counts were classified as no polypharmacy (<5), polypharmacy (5–9), and hyper‐polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1‐year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper‐polypharmacy (63% and 25%, respectively, if including HF medications). Non‐HF polypharmacy was more common in older white patients from high‐income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non‐HF medication use were less likely to receive guideline‐directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1‐year mortality were 1.16 (95% confidence interval CI 1.08–1.25) for polypharmacy and 1.46 (95% CI 1.31–1.63) for hyper‐polypharmacy versus no polypharmacy. After adjustment, hyper‐polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01–1.33). Conclusions Non‐HF polypharmacy in HF is common worldwide, particularly in high‐income regions. Its association with reduced use of guideline‐directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1‐year mortality, underscores the importance of addressing polypharmacy in HF. Clinical Trial Registration: ClinicalTrials.gov NCT02595814.