Polypharmacy in Patients with Cardiovascular Disease: A Narrative Review of Concepts, Clinical Impacts and Management Strategies
DOI:
https://doi.org/10.31941/benzena.v5i01.7973Keywords:
polypharmacy, cardiovascular disease, heart failure, medication review, deprescribing.Abstract
Background: Cardiovascular disease remains one of the leading causes of morbidity and mortality worldwide, including in Indonesia. Patients with cardiovascular disease, particularly those with heart failure, commonly present with multiple comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, atrial fibrillation, and psychological disorders. These conditions often require the concurrent use of multiple medications that are clinically indicated and guideline based, however it may also increase the risk of drug interactions, adverse drug reactions, poor adherence, and treatment burden.
Objective: This narrative review aims to examine the polypharmacy in patients with cardiovascular disease, particularly heart failure, including its definition, prevalence, contributing factors, clinical impacts, management strategies.
Results: Polypharmacy is commonly defined as the concurrent use of five or more medications. Polypharmacy is highly prevalent among patients with heart failure, especially older adults and those with multiple comorbidities. The impact of polypharmacy is not always negative, as some medications, such as guideline-directed medical therapy, have been shown to improve prognosis in patients with heart failure. However, inappropriate polypharmacy may increase the risk of potentially inappropriate medications, therapeutic competition, drug interactions, adverse drug reactions, hospitalization, reduced quality of life, and medication non-adherence. Management strategies include medication review, medication reconciliation, medication therapy management, deprescribing, and multidisciplinary collaboration among physicians, pharmacists, and other healthcare professionals.
Conclusion: Polypharmacy is a common condition among patients with cardiovascular disease, particularly those with heart failure. Its management should be individualized, systematic, multidisciplinary, and patient-centered. The primary focus should not merely be reducing the number of medications, but ensuring that each medication is appropriately indicated, safe, effective, and provides benefits that outweigh its risks.
Keywords: polypharmacy, cardiovascular disease, heart failure, medication review, deprescribing.
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Baron-Franco, B., McLean, G., Mair, F. S., Roger, V. L., Guthrie, B., & Mercer, S. W. (2017). Comorbidity and polypharmacy in chronic heart failure: A large cross-sectional study in primary care. British Journal of General Practice, 67(658), e314–e320. https://doi.org/10.3399/bjgp17X690533
Beezer, J., Clark, A. L., Todd, A., Kingston, A., & Husband, A. (2025). The association between polypharmacy and mortality in patients with heart failure: Results from the PULSE dataset. ESC Heart Failure, 12(6), 4316–4325. https://doi.org/10.1002/ehf2.15445
Brinker, L. M., Konerman, M. C., Navid, P., Dorsch, M. P., McNamara, J., Willer, C. J., Tinetti, M. E., Hummel, S. L., & Goyal, P. (2021). Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction. American Journal of Medicine, 134(3), 374–382. https://doi.org/10.1016/j.amjmed.2020.07.023
Bergler, U., Ailabouni, N. J., Pickering, J. W., Hilmer, S. N., Mangin, D., Nishtala, P. S., & Jamieson, H. (2021). Deprescribing to reduce polypharmacy: study protocol for a randomised controlled trial assessing deprescribing of anticholinergic and sedative drugs in a cohort of frail older people living in the community. Trials, 22(1), 1–12. https://doi.org/10.1186/s13063-021-05711-w
Goyal, P., Mangal, S., Krishnaswami, A., & Rich, M. W. (2021). Polypharmacy in Heart Failure: Progress But Also Problem. American Journal of Medicine, 134(9), 1071–1073. https://doi.org/10.1016/j.amjmed.2021.05.007
Green, A. R., Quiles, R., Daddato, A. E., Merrey, J., Weffald, L., Gleason, K., Xue, Q. L., Swarthout, M., Feeser, S., Boyd, C. M., Wolff, J. L., Blinka, M. D., Libby, A. M., & Boxer, R. S. (2024). Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study. Journal of the American Geriatrics Society, 72(7), 1973–1984. https://doi.org/10.1111/jgs.18867
Jamieson, H., Nishtala, P. S., Bergler, H. U., Weaver, S. K., Pickering, J. W., Ailabouni, N. J., Abey-Nesbit, R., Gullery, C., Deely, J., Gee, S. B., Hilmer, S. N., & Mangin, D. (2023). Deprescribing Anticholinergic and Sedative Drugs to Reduce Polypharmacy in Frail Older Adults Living in the Community: A Randomized Controlled Trial. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 78(9), 1692–1700. https://doi.org/10.1093/gerona/glac249
Kementerian Kesehatan Republik Indonesia. (2022). Penyakit jantung penyebab utama kematian, Kemenkes perkuat layanan primer. Kementerian Kesehatan Republik Indonesia.
Kraut, R. Y., Youngson, E., Sadowski, C. A., Bakal, J. A., Faulder, D., Korownyk, C. S., Vucenovic, A., Eurich, D. T., Manca, D. P., Lundby, C., Kivi, P., Manville, M., & Garrison, S. R. (2024). Antihypertensive deprescribing in frail term care residents ( OptimizeBP ): protocol for a prospective , randomised , label pragmatic trial. 1, 1–11. https://doi.org/10.1136/bmjopen-2024-084619
McCarthy, C., Clyne, B., Boland, F., Moriarty, F., Flood, M., Wallace, E., & Smith, S. M. (2022). GP-delivered medication review of polypharmacy, deprescribing, and patient priorities in older people with multimorbidity in Irish primary care (SPPiRE Study): A cluster randomised controlled trial. PLoS Medicine, 19(1), 1–19. https://doi.org/10.1371/journal.pmed.100386
Minamisawa, M., Claggett, B., Suzuki, K., Hegde, S. M., Shah, A. M., Desai, A. S., Lewis, E. F., Shah, S. J., Sweitzer, N. K., Fang, J. C., Anand, I. S., O’Meara, E., Rouleau, J. L., Pitt, B., Pfeffer, M. A., Solomon, S. D., & Vardeny, O. (2021). Association of Hyper-Polypharmacy With Clinical Outcomes in Heart Failure With Preserved Ejection Fraction. Circulation: Heart Failure, 14(11), E008293. https://doi.org/10.1161/CIRCHEARTFAILURE.120.008293
Navid, P., Nguyen, L., Jaber, D., Zarzuela, K., Musse, M., Lu Wang, M., Requijo, T., Kozlov, E., Masterson Creber, R. M., Hilmer, S. N., Lachs, M., & Goyal, P. (2021). Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. Journal of the American Geriatrics Society, 69(7), 1948–1955. https://doi.org/10.1111/jgs.17204
Osanlou, R., Walker, L., Hughes, D. A., Burnside, G., & Pirmohamed, M. (2022). Adverse drug reactions , multimorbidity and polypharmacy : a prospective analysis of 1 month of medical admissions. 1–7. https://doi.org/10.1136/bmjopen-2021-055551
Ozasa, N., Kato, T., Morimoto, T., Yaku, H., Yamamoto, E., Inuzuka, Y., Tamaki, Y., Kitai, T., Washida, K., Seko, Y., Yoshikawa, Y., Sato, Y., Motoki, H., Kuwahara, K., & Kimura, T. (2023). Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure. Journal of Cardiovascular Nursing, 38(1), 33–43. https://doi.org/10.1097/JCN.0000000000000885
Perreault, S., Schnitzer, M. E., Disso, E., Qazi, J., Boivin-Proulx, L. A., & Dorais, M. (2022). Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study. Scientific Reports, 12(1), 1–11. https://doi.org/10.1038/s41598-022-24285-4
Roger, V. L., Banaag, A., Korona-Bailey, J., Wiley, T. M. P., Turner, C. E., Haigney, M. C., & Koehlmoos, T. P. (2023). Prevalence of Heart Failure Stages in a Universal Health Care System: The Military Health System Experience. American Journal of Medicine, 136(11), 1079-1086.e1. https://doi.org/10.1016/j.amjmed.2023.07.007
Sekiya, Y., Fujiki, S., Tsuchiya, H., Kashimura, T., Okura, Y., Kodera, K., Watanabe, H., Takahashi, K., Bannai, S., Hatano, T., Tanaka, T., Kitamura, N., Minamino, T., & Inomata, T. (2025). Association of Medication Profiles, Including Polypharmacy, Guideline-Directed Medical Therapy, and Potentially Inappropriate Medications, With All-Cause Mortality in Older Adults With Heart Failure, With or Without Frailty and Disability. Circulation Journal, 89(10), 1662–1671. https://doi.org/10.1253/circj.CJ-25-0200
Somberg, J. (2022). Heart Failure Research and Polypharmacy. Cardiology Research, 13(1), 2022. https://doi.org/10.14740/cr1356
Stefil, M., Dixon, M., Bahar, J., Saied, S., Mashida, K., Heron, O., Shantsila, E., Walker, L., Akpan, A., Lip, G. Y. H., & Sankaranarayanan, R. (2022). Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist. Cardiac Failure Review, 8. https://doi.org/10.15420/cfr.2022.14
Unlu, O., Levitan, E. B., Reshetnyak, E., Kneifati-Hayek, J., Diaz, I., Archambault, A., Chen, L., Hanlon, J. T., Maurer, M. S., Safford, M. M., Lachs, M. S., & Goyal, P. (2020). Polypharmacy in Older Adults Hospitalized for Heart Failure. Circulation: Heart Failure, 13(11), E006977. https://doi.org/10.1161/CIRCHEARTFAILURE.120.006977
Yang, H. W., Yu, C. H., Huang, T. Y., Huang, C. H., & Su, Y. J. (2025). Reducing polypharmacy through deprescribing in the emergency department. Medicine (United States), 104(10), e41590. https://doi.org/10.1097/MD.0000000000041590
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