Skip to content
DraconiticResearch
Search Sources API
197,768 studies31 sourcesUpdated 52 min ago
Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Impact of Severe Polypharmacy on Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis

  • Alejandro Valcuende-Rosique1,2,3
  • Clara Bonanad4,5,6,7
  • Sergio Garcia-Blas5,6,7
  • Guillermo Barreres5
  • Nora Garcia-Collado5
  • Cristina Monleon-Bonet5
  • Daniela Maidana8
  • Maria Soledad Palacio9
  • Javier Valcuende-Rosique10
  • Francisco Jose Tarazona-Santabalbina2,3,11
11 affiliations
  1. 1Department of Pharmacy, Hospital Padre Jofre, 46017 Valencia, Spain
  2. 2Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
  3. 3Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
  4. 4Department of Medicine, University of Valencia, 46010 Valencia, Spain
  5. 5Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
  6. 6Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
  7. 7Department of Cardiology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
  8. 8Department of Cardiovascular Surgery, Hospital Universitario Virgen Macarena, 41042 Sevilla, Spain
  9. 9Servicio de Cardiología del Centro de Especialidades Médicas de Referencia Nº1 (CEMAR Nº1), Buenos Aires C1427BON, Argentina
  10. 10Cardiology Department, Hospital Universitario de Sagunto, Port de Sagunt, 46520 Valencia, Spain
  11. 11Medical Directorate, Hospital La Magdalena, 12004 Castellón de la Plana, Spain
Open at sourceDOICite

Abstract

Background: Polypharmacy is highly prevalent in patients with heart failure (HF), but the prognostic significance of severe polypharmacy remains uncertain. This systematic review and meta-analysis evaluated its association with all-cause mortality in adults with HF. Methods: PubMed, MEDLINE, Embase, Scopus and the Cochrane Library were searched from inception through August 2026. Observational studies assessing severe polypharmacy (the highest medication-burden category in each study; ≥9 to ≥15 medications) and all-cause mortality in adults with HF were eligible. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Leave-one-out sensitivity analyses and post hoc threshold-specific analyses were performed. Risk of bias and certainty of evidence were assessed using the Newcastle–Ottawa Scale (NOS) and GRADE, respectively. The protocol was registered in PROSPERO (CRD420261507517). Results: Nine studies included 44,213 patients. Severe polypharmacy was not significantly associated with all-cause mortality (HR 1.04, 95% CI 0.86–1.26; p = 0.67; I2 = 79%). NOS scores ranged from 6 to 9. Leave-one-out HRs ranged from 0.996 to 1.097, with all 95% CIs including 1. In six studies defining severe polypharmacy as ≥10 medications, the pooled HR was 1.15 (95% CI 1.00–1.32; p = 0.054; I2 = 37.8%). Certainty of evidence was very low because of serious inconsistency and imprecision. Conclusions: No statistically significant association was identified, but very low certainty of evidence precludes firm conclusions, and clinically important associations cannot be excluded. Medication count should be interpreted alongside treatment appropriateness and clinical complexity.

Related

  1. IMPACT OF INTRAVENOUS IRON THERAPY IN PATIENTS WITH HEART FAILURE AND IRON DEFICIENCY: A SYSTEMATIC REVIEW
    Beatriz BARSI CUNHA, Lara DAMASCENO DUARTE, Maria Eduarda SANTOS DE OLIVEIRA +8
    Hematology, Transfusion and Cell TherapyPeer-reviewedCC BYFull textEndocrinology & metabolismDOAJ
  2. Long-term outcomes and impact of diagnostic coding of patients with heart failure identified in primary care: insights from the OSCAR-HF cohort.
    Willem Raat, Nele Vanderroost, Bert Aertgeerts +7
    Open heartPeer-reviewedCC BY-NCFull textCardiovascular medicineEurope PMC
  3. Incidence of Osteoradionecrosis and Dental Implant Survival in Patients With Irradiated Head and Neck Malignancies: A Systematic Review and Meta-Analysis
    Nirmalya Chatterjee, Amrita Ghosh, Arka Swarnakar +1
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  4. Multidisciplinary team management and the survival of head and neck cancer patients: a systematic review and meta-analysis
    Hanan M. Qasem, Ali O. Aldamen, Muhammad Idrees +7
    Annals of medicine and surgery (2012)Peer-reviewedCC BYFull textGeneral medicineEurope PMC
  5. Delayed left ventricular remodelling in patients with heart failure and reduced ejection fraction: a systematic review.
    Laurence Whittaker, Visvesh Jeyalan, Matthew Dewhurst +5
    Open heartPeer-reviewedCC BY-NCFull textCardiovascular medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{valcuenderosique2026impact,
  title = {{Impact of Severe Polypharmacy on Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis}},
  author = {Alejandro Valcuende-Rosique and Clara Bonanad and Sergio Garcia-Blas and Guillermo Barreres and Nora Garcia-Collado and Cristina Monleon-Bonet and Daniela Maidana and Maria Soledad Palacio and Javier Valcuende-Rosique and Francisco Jose Tarazona-Santabalbina},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218519},
  url = {https://www.mdpi.com/2077-0383/15/21/8519},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of Severe Polypharmacy on Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis
AU  - Alejandro Valcuende-Rosique
AU  - Clara Bonanad
AU  - Sergio Garcia-Blas
AU  - Guillermo Barreres
AU  - Nora Garcia-Collado
AU  - Cristina Monleon-Bonet
AU  - Daniela Maidana
AU  - Maria Soledad Palacio
AU  - Javier Valcuende-Rosique
AU  - Francisco Jose Tarazona-Santabalbina
PY  - 2026
DA  - 2026/11/02
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218519
UR  - https://www.mdpi.com/2077-0383/15/21/8519
AB  - Background: Polypharmacy is highly prevalent in patients with heart failure (HF), but the prognostic significance of severe polypharmacy remains uncertain. This systematic review and meta-analysis evaluated its association with all-cause mortality in adults with HF. Methods: PubMed, MEDLINE, Embase, Scopus and the Cochrane Library were searched from inception through August 2026. Observational studies assessing severe polypharmacy (the highest medication-burden category in each study; ≥9 to ≥15 medications) and all-cause mortality in adults with HF were eligible. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Leave-one-out sensitivity analyses and post hoc threshold-specific analyses were performed. Risk of bias and certainty of evidence were assessed using the Newcastle–Ottawa Scale (NOS) and GRADE, respectively. The protocol was registered in PROSPERO (CRD420261507517). Results: Nine studies included 44,213 patients. Severe polypharmacy was not significantly associated with all-cause mortality (HR 1.04, 95% CI 0.86–1.26; p = 0.67; I2 = 79%). NOS scores ranged from 6 to 9. Leave-one-out HRs ranged from 0.996 to 1.097, with all 95% CIs including 1. In six studies defining severe polypharmacy as ≥10 medications, the pooled HR was 1.15 (95% CI 1.00–1.32; p = 0.054; I2 = 37.8%). Certainty of evidence was very low because of serious inconsistency and imprecision. Conclusions: No statistically significant association was identified, but very low certainty of evidence precludes firm conclusions, and clinically important associations cannot be excluded. Medication count should be interpreted alongside treatment appropriateness and clinical complexity.
SN  - 2077-0383
ER  -