Abstract 15263: Prognostic Impact of the Hyper-Polypharmacy on the Long-Term Outcomes in Patients With Chronic Heart Failure Following Cardiac Resynchronization Therapy

Abstract

Introduction: Optimal drug therapy improves long-term prognosis in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, but it exposes patients to the risk of polypharmacy. Hypothesis: This study aimed to determine the association between hyper-polypharmacy and adverse events in patients with CHF after cardiac resynchronization therapy (CRT). Methods: This retrospective study evaluated 134 patients (90 male, mean age 70.6 ± 9.7 years; 31 (23%) old myocardial infarction, 57 (43%) dilated cardiomyopathy, 46 (34%) others) who underwent CRT implantation between 2004 and 2020 and were followed for at least one year after the operation (mean, 1071 ± 649 days). The hyper-polypharmacy group (n = 74) was defined as patients taking total of 10 or more medications at discharge. The primary endpoint was major adverse cardiovascular events (MACE) including cardiovascular death, hospitalization for heart failure (HHF), cerebral infarction, acute myocardial infarction, and cardiac arrest. The secondary endpoints include HHF and all-cause mortality. Results: MACE occurred in 62 (46%), HHF occurred in 55 (41%) and all-cause mortality occurred in 24 (18%) patients. Kaplan-Meier survival analysis demonstrated that hyper-polypharmacy group had a higher incidence of MACE (log-rank 8.29; P = 0.004), HHF (log-rank 8.55; P = 0.0035) and all-cause mortality (log-rank 7.83; P = 0.0051). Cox proportional hazards regression analysis also revealed that the hyper-polypharmacy group had a higher incidence of MACE (HR 2.15; 95% CI:1.28 - 3.75, P = 0.0036), HHF (HR 2.39; 95% CI:1.32 - 4.19, P = 0.0031) and all-cause mortality (HR 3.72; 95% CI:1.49 - 11.2, P = 0.0038). Multiple Cox proportional hazards analysis revealed that hyper-polypharmacy was an independent predictor of MACE (hazard ratio 2.00; 95% CI:1.18 - 3.50, P = 0.01). Conclusions: Hyper-polypharmacy may predict the occurrence of MACE in patients with CHF undergoing CRT implantation.