A new study highlights entrenched polypharmacy in managing heart failure and calls for multidisciplinary strategies to optimise care, particularly in ageing, frail and multimorbid populations.
Patient Understanding through Longitudinal Surveillance and Evaluation (PULSE) is a bespoke, single-centre, retrospective, longitudinal, observational cohort database that tracks patients from their initial heart failure admission through subsequent hospitalisations to death or the end of the study period.
It provides a comprehensive view of how medication burden evolves over time, enabling researchers to assess the progression of medication use and complexity and underscoring the need for more nuanced therapeutic strategies.
In this analysis, 660 patients (55.6% male, mean age 76.1 years) were included, with the first heart failure admission used to define baseline polypharmacy. The median number of medications per patient was nine on admission, rising to 10 at discharge.
Notably, 87.3% of patients met the criteria for polypharmacy at the point of admission, increasing to 95.1% at discharge (p<0.001), suggesting a consistent and significant accumulation of medications during inpatient care.
Quantifying polypharmacy complexity
In addition to the number of medications, the study applied the mean medication complexity index (MRCI) to quantify the treatment burden. The mean MRCI score rose from 28.5 on admission to 31.8 at discharge (p<0.001), indicating more medications and increasingly complex regimens.
Higher medication counts were closely linked to advancing age; greater comorbidity burden, measured by the Charlson Comorbidity Index; increased frailty; longer hospital stays; and higher New York Heart Association class symptoms.
Importantly, polypharmacy was significantly more prevalent among patients with heart failure with preserved ejection fraction (HFpEF) compared to those with reduced ejection fraction (p=0.002).
While cardiovascular medications accounted for half of all medications, prescribing of heart failure therapies declined as polypharmacy increased. This raises concern that amidst rising complexity, essential heart failure treatments may be deprioritised.
The findings suggest that polypharmacy is not a late-stage issue but is prevalent from the point of first hospital contact. Patients with HFpEF, who are often older and have more comorbidities, appear particularly vulnerable to polypharmacy, underscoring the need for tailored management approaches.
Reference
Beezer J et al. Polypharmacy on first admission to hospital for people with heart failure: baseline findings from the PULSE cohort. Eur Heart J Qual Clin Outcomes 2025;May 16:qcaf032.
