Polypharmacy in atrial fibrillation linked to several adverse outcomes

Polypharmacy is highly prevalent among patients with atrial fibrillation (AF) and contributes to an increased risk of adverse outcomes, such as all-cause mortality, major bleeding and poorer physical function, among others, according to the results of a meta-analysis.

Researchers searched multiple online databases for studies, including posthoc analyses of prospective randomized controlled trials or those observational in nature, that evaluated the effect of polypharmacy on clinically significant outcomes in AF.

Six studies were identified from the systematic review, of which three studies reporting on common outcomes were included in the meta-analysis. The pooled population comprised 33,602 individuals (37.2 percent female), and the prevalence of polypharmacy ranged between 40.1 percent (≥5 cardiovascular medicines) and 78.8 percent (≥5 overall medicines). Risk of bias was assessed as low in two studies and moderate in the third.

Moderate (5–9 medicines) and severe (>9 medicines) polypharmacy was documented in 42.7 percent and 20.7 percent of patients, respectively. Both were associated with a significant increase in the risk of the following adverse outcomes: all-cause mortality (hazard ratio [HR], 1.36, 95 percent confidence interval [CI], 1.20­–1.54 and HR, 1.84, 95 percent CI, 1.40–2.41, respectively; p<0.001), major bleeding (HR, 1.32, 95 percent CI, 1.14–1.52 and HR, 1.68, 95 percent CI, 1.35–2.09, respectively; p<0.001) and clinically relevant nonmajor bleeding (HR, 1.12, 95 percent CI, 1.03–1.22 and HR, 1.48, 95 percent CI, 1.33–1.64, respectively; p<0.01).

There was no statistically significant relationship seen between polypharmacy and stroke or systemic embolism or intracranial bleeding. Among other examined outcomes, associations were observed for cardiovascular death, hospitalization, reduced quality of life and poorer physical function.

In light of the findings, the researchers called for regular review of a patient’s prescribed and nonprescribed medicines to identify inappropriate polypharmacy and provide opportunities to minimize polypharmacy-associated harm.