Influence of polypharmacy on patients with heart failure with preserved ejection fraction: a retrospective analysis on adverse outcomes in the TOPCAT trial.

Autor:	Wu Y; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China., Zhu W; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China., He X; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China., Xue R; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China., Liang W; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., Wei F; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., Wu Z; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., Zhou Y; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., Wu D; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., He J; NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou 510080, PR China., Dong Y; National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China., Liu C; Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China.
Jazyk:	angličtina
Zdroj:	The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2020 Dec 28; Vol. 71 (702), pp. e62-e70. Date of Electronic Publication: 2020 Dec 28 (Print Publication: 2021).
DOI:	10.3399/bjgp21X714245
Abstrakt:	Background: Polypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear. Aim: To evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients. Design and Setting: 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. Method: 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. Results: 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. Conclusion: 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. (© The Authors.)
Databáze:	MEDLINE
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