Key result
In patients with heart failure with preserved ejection fraction, super hyperpolypharmacy (≥15 medications) was associated with increased risks of heart failure hospitalization (HR 3.00) and all-cause hospitalization (HR 2.29), but a reduced risk of all-cause death (HR 0.51) compared to taking <5 medications.
Why the study?
Polypharmacy is common in heart failure, but its effect on adverse outcomes in patients with heart failure with preserved ejection fraction remains unclear.
Does a high medication burden (polypharmacy) increase the risk of adverse outcomes in patients with heart failure with preserved ejection fraction?
Cohort (n=1,761)
Yes
Does a high medication burden (polypharmacy) increase the risk of adverse outcomes in patients with heart failure with preserved ejection fraction?
Hazard Ratio: 1.37 (95% CI 0.83–2.25)
Absolute Event Rate: 16.8% vs 6.3%
p-value: p=0.22
In patients with HFpEF, a higher baseline medication burden is paradoxically associated with lower all-cause mortality but significantly increases the risk of heart failure and all-cause hospitalizations.
May warrant medication review in HFpEF to address hospitalization risks; hypothesis-generating for polypharmacy effects on mortality.
BACKGROUND: Polypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear. AIM: To evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients. DESIGN AND SETTING: A retrospective analysis performed on patients in the Americas region (including the US, Canada, Argentina, and Brazil) with symptomatic HF and a left ventricular ejection fraction ≥45% in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, an international, randomised, double-blind, placebo-controlled study conducted during 2006-2013 in six countries. METHOD: Patients were categorised into four groups: controls (<5 medications), polypharmacy (5-9 medications), hyperpolypharmacy, (10-14 medications), and super hyperpolypharmacy (≥15 medications). The outcomes and predictors in all groups were assessed. RESULTS: Of 1761 participants, the median age was 72 years; 37.5% were polypharmacy, 35.9% were hyperpolypharmacy, and 19.6% were super hyperpolypharmacy, leaving 7.0% having a low medication burden. In multivariable regression models, three experimental groups with a high medication burden were all associated with a reduction in all-cause death, but increased risks of HF hospitalisation and all-cause hospitalisation. Furthermore, several comorbidities (dyslipidemia, thyroid diseases, diabetes mellitus, and chronic obstructive pulmonary disease), a history of angina pectoris, diastolic blood pressure <80 mmHg, and worse heart function (the New York Heart Association functional classification level III and IV) at baseline were independently associated with a high medication burden among patients with HFpEF. CONCLUSION: A high prevalence of high medication burden at baseline was reported in patients with HFpEF. The high medication burden might increase the risk of hospital readmission, but not the mortality.
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Wu et al. (2020) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,761). High medication burden (polypharmacy) vs. Low medication burden (<5 medications) was evaluated on Composite of cardiovascular death, aborted cardiac arrest, or HF hospitalisation (HR 1.37, 95% CI 0.83 to 2.25, p=0.22). In patients with heart failure with preserved ejection fraction, super hyperpolypharmacy (≥15 medications) was associated with increased risks of heart failure hospitalization (HR 3.00) and all-cause hospitalization (HR 2.29), but a reduced risk of all-cause death (HR 0.51) compared to taking <5 medications.
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