Polypharmacy and health outcomes in atrial fibrillation: a systematic review and meta-analysis

Abstract

ObjectiveTo undertake a systematic review and meta-analysis examining the impact of polypharmacy on health outcomes in atrial fibrillation (AF).Data sourcesPubMed and Embase databases were searched from inception until 31 July 2019. Studies including post hoc analyses of prospective randomised controlled trials or observational design that examined the impact of polypharmacy on clinically significant outcomes in AF including mortality, hospitalisations, stroke, bleeding, falls and quality of life were eligible for inclusion.ResultsA total of six studies were identified from the systematic review, with three studies reporting on common outcomes and used for a meta-analysis. The total study population from the three studies was 33 602 and 37.2% were female. Moderate and severe polypharmacy, defined as 5–9 medicines and >9 medicines, was observed in 42.7% and 20.7% of patients respectively, and was associated with a significant increase in all-cause mortality (Hazard ratio [HR] 1.36, 95% CI 1.20 to 1.54, p<0.001; HR 1.84, 95% CI 1.40 to 2.41, p<0.001, respectively), major bleeding (HR 1.32, 95% CI 1.14 to 1.52, p<0.001; HR 1.68, 95% CI 1.35 to 2.09, p<0.001, respectively) and clinically relevant non-major bleeding (HR 1.12, 95% CI 1.03 to 1.22, p<0.01; HR 1.48, 95% CI 1.33 to 1.64, p<0.01, respectively). There was no statistically significant association between polypharmacy and stroke or systemic embolism or intracranial bleeding. Among other examined outcomes, polypharmacy was associated with cardiovascular death, hospitalisation, reduced quality of life and poorer physical function.ConclusionsPolypharmacy is highly prevalent in the AF population and is associated with numerous adverse outcomes.PROSPERO registration numberCRD42018105298.

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

“…The vast majority of those (n = 112) are mere numerical definitions, meaning that only the number of drugs is used to check for the presence of polypharmacy in an individual [14]. These numerical definitions are very heterogenous and partly include associated terms such as minor [17][18][19], mild [20], moderate [21], major [19,[22][23][24][25] and excessive polypharmacy [24,[26][27][28][29] to characterize the severity of polypharmacy [14]. Besides, the threshold for these numerical definitions of polypharmacy ranges from 2 or more to 11 or more drugs [14] and the cut-off/range for the associated terms partly varies as well.…”

“…Besides, the threshold for these numerical definitions of polypharmacy ranges from 2 or more to 11 or more drugs [ 14 ] and the cut-off/range for the associated terms partly varies as well. For instance, moderate polypharmacy is defined as the daily intake of 4–5 medication in one source [ 14 ] and as the intake of 5–9 drugs in another [ 21 ].…”

Economic burden of rivaroxaban and warfarin among nonvalvular atrial fibrillation patients with obesity and polypharmacy

“…Over the follow-up period (rivaroxaban: † For the analysis up to 12 months, the mean (median) length of observation period was 9.9 (12) months for the rivaroxaban cohort and 9.7 ( 12) months for the warfarin cohort. For the analysis up to 36 months, the length of observation period was 20.3 (19) months for the rivaroxaban cohort and 19.5 (18) months for the warfarin cohort.…”

Relationship between number of medications and incidence of falls or bone fracture in elderly patients with non‐valvular atrial fibrillation: Shinken database analysis

“…reported that polypharmacy (≥5 prescribed medications) was experienced by 40% of AF patients 5 . Polypharmacy warrants attention in elderly AF patients because, in addition to its prevalence, it increases the risk of mortality, hospitalization, and adverse drug reactions 5–9 …”