Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure

BackgroundPolypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities.ObjectiveThe aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year.MethodsWe evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, <= 5; quartile 2, 6-8; quartile 3, 9-11; and quartile 4, >= 12).ResultsAt hospital discharge, the median number of medications was 8 (interquartile range, 6-11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01).ConclusionsIn the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients.