Abstract
With the increasing frequency of heart failure (HF) in elderly patients, polypharmacy has become a major concern owing to its adverse outcomes. However, reports on the clinical impact of polypharmacy and discharge medications in hospitalized super-aged patients with acute HF are rare. Data from 682 patients aged 80 years or older, hospitalized for treating acute HF, were analyzed. We recorded the number of medications at discharge and classified them into three groups: HF, non-HF cardiovascular, and non-cardiovascular medications. We investigated the correlation of polypharmacy, defined as daily administration of 10 or more medications at discharge, and the use of discharge medications with post-discharge prognosis. Polypharmacy was recorded in 24.3% of enrolled patients. Polypharmacy was not an independent predictor of all-cause mortality, the incidence of cardiac-related death, or HF-associated rehospitalization; however, the number of non-cardiovascular medications, multiple usage of potentially inappropriate medications, use of mineralocorticoid receptor antagonists, and doses of loop diuretics were associated with poor prognosis. Polypharmacy was significantly associated with higher mortality in patients with Barthel index ≥ 60 at discharge; hence, physical function at discharge was useful for the stratification of prognostic impacts of polypharmacy. The current study demonstrated that polypharmacy was not essentially associated with poor prognosis in super-aged patients with acute HF. Appropriate medications that consider the patient’s physical function, rather than polypharmacy itself, are important for the management of HF.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors are grateful to the multidisciplinary heart failure team, at Anjo Kosei Hospital for their help in the acquisition of clinical data.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by YU, KS, and SI. The first draft of the manuscript was written by YU and RS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The retrospective study protocol was approved by the Anjo Kosei Hospital Ethics Committee (Approval No. R21-075). According to the Japanese Ministry of Health, Labour and Welfare guidelines, informed consent was not required owing to the retrospective design of this study. Patients could opt out of sharing their information via the hospital website.
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Uemura, Y., Shibata, R., Sawada, K. et al. Prognostic impact of polypharmacy and discharge medications in octogenarians and nonagenarian patients with acute heart failure. Heart Vessels 39, 514–523 (2024). https://doi.org/10.1007/s00380-024-02366-w
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DOI: https://doi.org/10.1007/s00380-024-02366-w