Introduction: Acute decompensated heart failure (ADHF) treatment requires multi-drugs regimens in guidelines. Furthermore ADHF patients are known to have many comorbidities, and their number of medications is expected to increase. Polypharmacy exerts a negative influence on drug interactions and medical economics, but there is few research on the relationship between polypharmacy and prognosis in heart failure patients. We evaluated the value as a prognostic predictor of the number of drugs in ADHF patients.
Methods: The number of drugs at admission prescribed (ND), clinical characteristics and prognosis were retrospectively evaluated in 210 patients, who were hospitalized in Showa University Fujigaoka Hospital for ADHF from January 2015 to May 2016.
Results: By Cox regression analysis, the significant independent predictors were ND, serum sodium and cholinesterase for all-cause death, ND and serum sodium for cardiac death, ND, age, use of anticoagulant and estimated glomerular filtration rate (eGFR) for composite endpoint (all-cause death and/or re-hospitalization for ADHF) in average observation period of 349±224 days (P<0.05). Patients with more numbers of drugs showed worse outcomes (see figure). By a multiple linear regression, diabetes, use of beta blocker and anticoagulant, eGFR (ml/min/1.73m2), serum cholinesterase (IU/L) were significant predictors of ND (p<0.05). A significant regression equation was found (F(5, 177) = 26.990, p<0.001), with an R2 of 0.432. Participants’ predicted ND is equal to 16.454 + 1.315 (diabetes) + 2.500 (use of beta blocker) + 2.282 (use of anticoagulant) - 0.068 (eGFR) - 0.010 (serum cholinesterase).
Conclusion: Polypharmacy in patients hospitalized with ADHF reflected clinical co-morbid conditions, and had strong predictive value.