Polypharmacy in Heart Failure Patients: In the Era of Guidelines-Based Therapy Optimization

Abstract

Objectives: Comorbidities in heart failure (HF) patients require patients to take large amounts of medication (polypharmacy). This study aimed to assess the proportion of HF patients with polypharmacy and comorbidities that increase the risk of polypharmacy.

Methods: This cross-sectional study was conducted at Cardiovascular Hospital in Cirebon, Indonesia. Samples were taken at outpatient clinics from January to December 2023 using total sampling method. Data was taken from electronic medical records. Patients with incomplete medical record data were excluded from this study.

Key findings: A total of 494 HF patients were included. Most patients were male (53.4%) and aged 45-59 years (46%). Polypharmacy was found in 42.5% of HF patients and 36.7% of them had excessive polypharmacy (≥10 medications). Bivariate analysis showed that age group, ≥3 comorbidities, type 2 diabetes mellitus (T2DM), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), asthma and history of percutaneous coronary intervention (PCI) significantly increased the risk of polypharmacy (p<0.05). While from multivariate analysis, T2DM (AOR 12.35; 95%CI 6.78-22.49), CKD (AOR 7.18; 95%CI 2.73-18.91), COPD (AOR 7.15; 95%CI 3.35-15.26), asthma (AOR 11.18; 95%CI 2.22-56.29) and history of PCI (AOR 2.13; 95%CI 1.27-3.57) increased the risk of polypharmacy.

Conclusion: Heart failure patients with T2DM, CKD, history of PCI and pulmonary disease should receive special concern to reduce the risk of polypharmacy. Clinicians must make priority regarding medications that should be given according to recommended guidelines and address the patient’s comorbidities.