Polypharmacy definition and prevalence in heart failure: a systematic review

Abstract

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.

Potentially inappropriate medication among older patients with diabetic kidney disease

“…The study has proved that there was little difference between the 2017 Chinese and 2019 AGS/Beers criteria ( Tian et al, 2022 ), so the Beers criteria was also capable for Chinese. Our results are comparable to the PIM rate of ( Beezer et al, 2022 ), who reported that the incidence of PIM was 61.1% during hospitalization in older patients with heart failure. Still, the PIM after discharge was higher, which was 64.0%.…”

Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis

“…The prevalence estimates reported in this review are substantially higher than the general population including cohorts at high risk of experiencing polypharmacy such as elderly (Veehof et al, 2000), patients with chronic liver disease (Danjuma et al, 2022a), and people living with HIV (Danjuma et al, 2022b). However, the estimates were comparable to other populations that are also known to be more exposed to polypharmacy such as heart failure patients (Beezer et al, 2021).…”

Perceived Social Isolation in Heart Failure

“…Polypharmacy is associated with worse outcomes, including falls, disability, and hospitalization. 25 This additive burden in combination with social isolation may serve as a reason for discontinuation of medication.…”