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Polypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure

Guideline-directed medical therapy (GDMT) is less frequently achieved in patients with heart failure with reduced ejection fraction (HFrEF) who are on polypharmacy with nonpreferred agents, researchers report.

The findings come from a post hoc analysis of the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment) trial. Patients receiving 5 or more medications other than those in HFrEF GDMT were considered to have polypharmacy. The primary outcome was optimal triple therapy (renin-angiotensin-aldosterone blocker and beta-blocker at 50% of the target dose and a mineralocorticoid receptor antagonist at any dose) at 12 months.

“The study included 891 participants with HFrEF,” the authors write. “The median number of non-GDMT medications at baseline was 4 (IQR: 3-6), with 414 (46.5%) prescribed ≥5 and identified as being on polypharmacy. The proportion of participants who achieved optimal GDMT at the end of the 12-month follow-up was lower with vs without polypharmacy at baseline (15% vs 19%, respectively). In adjusted mixed models, the odds of achieving optimal GDMT over time were modified by baseline polypharmacy status (P for interaction < 0.001). Patients without polypharmacy at baseline had increased odds of achieving GDMT (OR: 1.16 [95% CI: 1.12-1.21] per 1-month increase; P < 0.001) but not patients with polypharmacy (OR: 1.01 [95% CI: 0.96-1.06)] per 1-month increase).”

Source: Journal of the American College of Cardiology