How to handle polypharmacy in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC

被引：0

作者：

Stolfo, Davide ^{[1
,2
,3
]}

Iacoviello, Massimo ^{[4
]}

Chioncel, Ovidiu ^{[5
,6
]}

Anker, Markus S. ^{[7
,8
,9
,10
,11
]}

Bayes-Genis, Antoni ^{[12
]}

Braunschweig, Frieder ^{[13
]}

Cannata, Antonio ^{[14
,15
]}

El Hadidi, Seif ^{[16
]}

Filippatos, Gerasimos ^{[17
]}

Jhund, Pardeep ^{[18
]}

Mebazaa, Alexandre ^{[19
,20
]}

Moura, Brenda ^{[21
]}

Piepoli, Massimo ^{[22
,23
]}

Ray, Robin ^{[24
,25
]}

Ristic, Arsen D. ^{[26
,27
]}

Seferovic, Petar ^{[28
]}

Simpson, Maggie ^{[29
]}

Skouri, Hadi ^{[30
]}

Tocchetti, Carlo Gabriele ^{[31
]}

Van Linthout, Sophie ^{[32
,33
]}

Vitale, Cristiana ^{[24
,25
]}

Volterrani, Maurizio ^{[34
,35
]}

Keramida, Kalliopi ^{[36
]}

Wassmann, Sven ^{[37
,38
]}

Lewis, Basil S. ^{[39
]}

Metra, Marco ^{[40
]}

Rosano, Giuseppe M. C. ^{[41
,42
]}

Savarese, Gianluigi ^{[1
,2
]}

机构：

[1] Soder Sjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden

[2] Karolinska Inst, Stockholm, Sweden

[3] Azienda Sanit Univ Friuli Cent, Cardiothorac Dept, Div Cardiol, Udine, Italy

[4] Univ Foggia, Dept Med & Surg Sci, Foggia, Italy

[5] Univ Med & Pharm Carol Davila, Bucharest, Romania

[6] Emergency Inst Cardiovasc Dis Prof CC Iliescu, Bucharest, Romania

[7] Charite CBF, German Heart Ctr, Berlin, Germany

[8] German Ctr Cardiovasc Res DZHK, Berlin, Germany

[9] Charite Univ Med Berlin, Berlin Inst Hlth, Ctr Regenerat Therapies BCRT, Berlin, Germany

[10] Free Univ Berlin, Berlin, Germany

[11] Humboldt Univ, Berlin, Germany

[12] Hosp Univ Germans Trias i Poujol, Heart Inst, Badalona, Spain

[13] Karolinska Inst, Dept Med Huddinge, Stockholm, Sweden

[14] Kings Coll London, British Heart Fdn Ctr Res Excellence, Fac Life Sci, Sch Cardiovasc Med, London, England

[15] Kings Coll Hosp NHS Fdn Trust, Cardiovasc Dept, London, England

[16] Univ Hertfordshire Egypt, Cairo, Egypt

[17] Natl & Kapodistrian Univ Athens, Athens Univ Hosp Attikon, Sch Med, Athens, Greece

[18] Univ Glasgow, Sch Cardiovasc & Metab Hlth, Glasgow, Scotland

[19] Univ Paris, INSERM, U942, MASCOT, Paris, France

[20] Hop Lariboisiere, AP HP, Dept Anesthesia & Crit Care Med, Paris, France

[21] Univ Porto, Armed Forces Hosp, Fac Med, Porto, Portugal

[22] IRCCS Policlin San Donato, Clin Cardiol, Milan, Italy

[23] Univ Milan, Dept Biomed Sci Hlth, Milan, Italy

[24] St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Cardiovasc Clin Acad Grp, London, England

[25] St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Cardiol Res Ctr, London, England

[26] Univ Belgrade, Med Fac, Belgrade, Serbia

[27] Univ Clin Ctr Serbia, Clin Cardiol, Belgrade, Serbia

[28] Univ Belgrade, Serbian Acad Sci & Arts, Fac Med, Heart Failure Ctr,Med Ctr, Belgrade, Serbia

[29] Queen Elizabeth Univ Hosp, Dept Cardiol, NHS Greater Glasgow & Clyde, Glasgow, Scotland

[30] Balamand Univ, Dept Cardiol, Sch Med, Beirut, Lebanon

[31] Univ Naples Federico II, Ctr Basic & Clin Immunol Res CISI, Interdept Ctr Clin & Translat Sci CIRCET, Interdept Hypertens Res Ctr CIRIAPA,Dept Translat, Naples, Italy

[32] Charite Univ Med Berlin, BIH Ctr Regenerat Therapies BCRT, Berlin Inst Hlth, Berlin, Germany

[33] German Ctr Cardiovasc Res DZHK, Partner Site Berlin, Berlin, Germany

[34] San Raffaele Open Univ, Dept Human Sci & Promot Qual Life, Rome, Italy

[35] IRCCS San Raffaele, Cardiopulm Dept, Rome, Italy

[36] Gen Anticanc Oncol Hosp Agios Savvas, Athens, Greece

[37] Cardiol Pasing, Munich, Germany

[38] Univ Saarland, Fac Med, Homburg, Germany

[39] Technion Israel Inst Technol, Lady Davis Carmel Med Ctr, Haifa, Israel

[40] Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlth, ASST Spedali Civili Brescia, Brescia, Italy

[41] San Raffaele Univ Rome, Chair Pharmacol, Dept Human Sci & Promot Qual Life, Rome, Italy

[42] San Raffaele Cassino Hosp, Cardiol, Cassino, Italy

来源：

EUROPEAN JOURNAL OF HEART FAILURE | 2025年

关键词：

Adherence; Comorbidities; Heart failure; Polypharmacy; POTENTIALLY INAPPROPRIATE MEDICATIONS; REDUCED EJECTION FRACTION; DECISION-SUPPORT-SYSTEMS; OLDER-ADULTS; CARE; PATTERNS; THERAPY; DISCREPANCIES; PREVALENCE; SURVIVAL;

D O I：

10.1002/ejhf.3642

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The multiplicity of coexisting comorbidities affecting patients with heart failure (HF), together with the availability of multiple treatments improving prognosis in HF with reduced ejection fraction, has led to an increase in the number of prescribed medications to each patient. Polypharmacy is defined as the regular use of multiple medications, and over the last years has become an emerging aspect of HF care, particularly in older and frailer patients who are more frequently on multiple treatments, and are therefore more likely exposed to tolerability issues, drug-drug interactions and practical difficulties in management. Polypharmacy negatively affects adherence to treatment, and is associated with a higher risk of adverse drug reactions, impaired quality of life, more hospitalizations and worse prognosis. It is important to adopt and implement strategies for the management of polypharmacy from other medical disciplines, including medication reconciliation, therapeutic revision and treatment prioritization. It is also essential to develop new HF-specific strategies, with the primary goal of avoiding the use of redundant treatments, minimizing adverse drug reactions and interactions, and finally improving adherence. This clinical consensus statement document from the Heart Failure Association of the European Society of Cardiology proposes a rationale, pragmatic and multidisciplinary approach to drug prescription in the current era of multimorbidity and 'multi-medication' in HF.

引用

页数：13

共 96 条

[71] Acosta-Garcia H., Ferrer-Lopez I., Ruano-Ruiz J., Santos-Ramos B., Molina-Lopez T., Computerized clinical decision support systems for prescribing in primary care: Main characteristics and implementation impact – protocol of an evidence and gap map, Syst Rev, 11, (2022)
[72] Spatz E.S., Ginsburg G.S., Rumsfeld J.S., Turakhia M.P., Wearable digital health technologies for monitoring in cardiovascular medicine, N Engl J Med, 390, pp. 346-356, (2024)
[73] Car J., Tan W.S., Huang Z., Sloot P., Franklin B.D., eHealth in the future of medications management: Personalisation, monitoring and adherence, BMC Med, 15, (2017)
[74] Eggerth A., Hayn D., Schreier G., Medication management needs information and communications technology-based approaches, including telehealth and artificial intelligence, Br J Clin Pharmacol, 86, pp. 2000-2007, (2020)
[75] Peacock E., Craig L.S., Krousel-Wood M., Electronic health strategies to improve medication adherence in patients with cardiometabolic disease: Current status and future directions, Curr Opin Cardiol, 37, pp. 307-316, (2022)
[76] Breathett K., Lewsey S., Brownell N.K., Enright K., Evangelista L.S., Ibrahim N.E., Et al., Implementation science to achieve equity in heart failure care: A scientific statement from the American Heart Association, Circulation, 149, pp. e1143-e1163, (2024)
[77] Allen L.A., Venechuk G., McIlvennan C.K., Page R.L., Knoepke C.E., Helmkamp L.J., Et al., An electronically delivered patient-activation tool for intensification of medications for chronic heart failure with reduced ejection fraction: The EPIC-HF trial, Circulation, 143, pp. 427-437, (2021)
[78] Desai A.S., Maclean T., Blood A.J., Bosque-Hamilton J., Dunning J., Fischer C., Et al., Remote optimization of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction, JAMA Cardiol, 5, pp. 1430-1434, (2020)
[79] Ghazi L., Yamamoto Y., Riello R.J., Coronel-Moreno C., Martin M., O'Connor K.D., Et al., Electronic alerts to improve heart failure therapy in outpatient practice: A cluster randomized trial, J Am Coll Cardiol, 79, pp. 2203-2213, (2022)
[80] DeVore A.D., Granger B.B., Fonarow G.C., Al-Khalidi H.R., Albert N.M., Lewis E.F., Et al., Effect of a hospital and postdischarge quality improvement intervention on clinical outcomes and quality of care for patients with heart failure with reduced ejection fraction: The CONNECT-HF randomized clinical trial, JAMA, 326, pp. 314-323, (2021)

← 1 2 3 4 5 6 7 8 9 10 →