The Increased Number of Drugs Without Guideline Recommendation is Associated with Poor Outcome in the Patients with Chronic Heart Failure

Purpose: Polypharmacy is usually defined as the chronic use of five or more medications and very common in patients with chronic heart failure (CHF) because current clinical guidelines (GL) recommend many drugs as class I. The purpose of this study is to evaluate the impact of the number of drugs recommended in GL (ACEI, ARB, β-blocker, Anti-aldosterone, Aspirin, Statin, Warfarin: GLd) and drugs not recommended in GL (non-GLd) for outcome in CHF patients separately. Methods: Study population included CHF patients who attended Hyogo College of Medicine hospital and participated in the J-MELODIC study. The relationship between the number of drugs at the entry and the primary endpoint (cardiovascular death or heart failure hospitalization) were analyzed using log-rank test and Cox proportional hazards regression analysis. Results: A total of 136 subjects (male 95, mean age of 69.3 years) were enrolled in the study. The use of 9 or more drugs was associated with an increase in the primary endpoint (log-rank test, P < .002). In Cox proportional hazards regression analysis, the number of non-GLd (P = .02), not the number of GLd (P = .94), was associated with poor outcome. Conclusions: An increase in the number of non-GLd, not the number of GLd, was associated with poor outcome.