Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined among heart failure patients in the literature, whether a standard definition in relation to heart failure could be identified and to describe the prevalence. The Healthcare Database Advanced Search (HDAS) was used to search EMBASE, MEDLINE, PubMed, Cinahl and PsychInfo from inception until March 2021. Articles were included of any design, in patients ≥ 18 years old, with a diagnosis of heart failure; that explicitly define and measure polypharmacy. Data were thereafter extracted and described using a narrative synthesis approach. A total of 7522 articles were identified with 22 meeting the inclusion criteria. No standard definition of polypharmacy was identified. The most common definition was that of " ≥ 5 medications." Polypharmacy prevalence was high in heart failure populations, ranging from 17.2 to 99%. Missing or heterogeneous methods for defining heart failure and poor patient cohort characterisation limited the impact of most studies. Polypharmacy, most commonly defined as ≥ 5 medications, is highly prevalent in the heart failure population. There is a need for an internationally agreed definition of polypharmacy, allowing accurate review of polypharmacy issues. Whether an arbitrary numerical cut-off is a suitable definition, rather than medication appropriateness, remains unclear. Further studies are necessary to understand the relationship between polypharmacy with specific types of heart failure and related comorbidities.

The framework delivers the vital first step needed to help standardise care, give pharmacists a blueprint for career progression and continuing professional development and bring clarity to the role of the pharmacist. Future collaboration between professional bodies and training providers is needed to develop structured programmes to align with the framework and facilitate training and resultant accreditation.

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Background With an ageing population and multimorbidity on the rise, polypharmacy is also increasing. Polypharmacy is common in patients with heart failure, possibly due to the application of evidence‐based therapy to improve prognosis and symptoms. Objectives To identify potentially inappropriate medications according to Beers criteria and the STOPP screening tool; To assess if the recommendations generated from applying these tools could have potentially unintended harmful outcomes in the context of a heart failure diagnosis. Method Medications for 30 patients, aged ≥75 years with an existing diagnosis of reduced ejection fraction (HFrEF) were extracted from the National Heart Failure Database. Patient medications were reviewed at the point of admission and recommendations documented and reviewed. Results Patients were prescribed an average of 11 medicines. Beers criteria generated 22 recommendations, of which 27% (6) could have potential detrimental effects on patient outcomes. STOPP screening generated 54 recommendations of which 65% (35) were considered to have potentially unintended harmful consequences in patients with heart failure. Conclusions Both guidelines for the review of potentially inappropriate medicines generated recommendations that could have potentially detrimental effects on heart failure management when considering patients with HFrEF.