acute decompensated heart failure, older, polypharmacy, prognosis



  1. Ozasa, Neiko MD, PhD
  2. Kato, Takao MD, PhD
  3. Morimoto, Takeshi MD, MPH
  4. Yaku, Hidenori MD, PhD
  5. Yamamoto, Erika MD, PhD
  6. Inuzuka, Yasutaka MD, PhD
  7. Tamaki, Yodo MD, PhD
  8. Kitai, Takeshi MD, PhD
  9. Washida, Koichi MSN
  10. Seko, Yuta MD
  11. Yoshikawa, Yusuke MD
  12. Sato, Yukihito MD, PhD
  13. Motoki, Hirohiko MD, PhD
  14. Kuwahara, Koichiro MD, PhD
  15. Kimura, Takeshi MD, PhD


Background: Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities.


Objective: The 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.


Methods: We 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).


Results: At 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).


Conclusions: In 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.