Journal Article Ahead of print 6 citations
PubMed: 41771119 DOI: 10.1093/ejhf/xuaf026
Magnitude of and outcome associated with inappropriate prescribing in heart failure with reduced ejection fraction: an analysis of 50 348 patients from the Swedish Heart Failure Registry.
Eur J Heart Fail
Authors: Seif El-Hadidi, Felix Lindberg, Lina Benson, Alicia Uijl, Davide Stolfo, Peter G M Mol, Raffaele Scorza, Carin Corovic Cabrera, Amr Abdin, Giuseppe M C Rosano, Gianluigi Savarese
Affiliations
- School of Population Health, Royal College of Surgeons (RCSI), Dublin, Ireland.
- Department of Clinical Science and Education, Söersjukhuset, Karolinska Institutet, Stockholm, Sweden.
- Department of Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
- Division of Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany.
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy.
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy.
Abstract
AIMS
Patients with heart failure and reduced ejection fraction (HFrEF) are frequently exposed to polypharmacy, placing them at risk of potentially inappropriate prescribing (PIP)-defined as use of drugs that may worsen HF prognosis, counteract guideline-directed medical therapies (GDMTs), or increase harmful interactions. The prevalence, predictors, and prognostic impact of PIP in HFrEF remain unclear. Therefore, the aim was to investigate the prevalence, predictors, and outcomes of PIP in a large, real-world HFrEF population.
METHODS
Patients with HFrEF enrolled in the Swedish HF Registry (2005-20) were included. The European Society of Cardiology position statement of PIP-HFrEF was used to retrieve PIP from the National Prescribed Drugs Register. Associations between PIP and outcomes were assessed using Cox proportional hazards and negative binomial regression for recurrent events.
RESULTS
Among 50 348 patients (median age 75 years, 29% female), 23 583 (47%) were prescribed ≥1 PIP. The most frequent agents were neuroleptics (29%), systemic steroids (10%), and NSAIDs (6%). Independent predictors included rheumatoid arthritis [odds ratio (OR) 3.39; 95% CI, 2.92-3.94], depression (OR 3.06; 95% CI, 2.74-3.42), chronic obstructive pulmonary disease (OR 1.86; 95% CI, 1.76-1.98), and gout (OR 1.48; 95% CI, 1.35-1.62). Patients on PIP were less likely to receive GDMT. Presence of ≥1 PIP was independently associated with increased 3-year risk of HF death (HR, 1.13; 95% CI, 1.04-1.23), all-cause and cardiovascular death, first and recurrent HF hospitalizations.
CONCLUSION
Nearly half of HFrEF patients received PIP medications, particularly those with multimorbidity, which was independently associated with worse outcomes and less GDMT use. Our data underscore the need for targeted strategies to reduce inappropriate prescribing in HFrEF.
MeSH
Registries, Inappropriate Prescribing, Heart Failure, Heart, Heart Failure, Systolic, Prevalence