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- Title
Influence of polypharmacy on patients with heart failure with preserved ejection fraction: a retrospective analysis on adverse outcomes in the TOPCAT trial.
- Authors
Wu, Yuzhong; Zhu, Wengen; He, Xin; Xue, Ruicong; Liang, Weihao; Wei, Fangfei; Wu, Zexuan; Zhou, Yuanyuan; Wu, Dexi; He, Jiangui; Dong, Yugang; Liu, Chen
- Abstract
<bold>Background: </bold>Polypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear.<bold>Aim: </bold>To evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients.<bold>Design and Setting: </bold>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.<bold>Method: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
NEW York (State); ARGENTINA; CANADA; BRAZIL; HEART failure; HEART failure patients; POLYPHARMACY; OBSTRUCTIVE lung diseases; VENTRICULAR ejection fraction; RETROSPECTIVE studies; SPIRONOLACTONE; LEFT heart ventricle; RESEARCH; RESEARCH methodology; PROGNOSIS; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; STROKE volume (Cardiac output); HEART physiology
- Publication
British Journal of General Practice, 2021, Vol 71, Issue 702, pe62
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp21X714245