Polypharmacy in heart failure: drugs to use and avoid

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Polypharmacy, defined as using 4 or more medications, is prevalent in heart failure (HF) patients.
• Patients with HF often have multiple comorbidities, complicating medication management.
• Nonprescription medication use further increases complexity in HF therapeutic regimens.

Purpose of the Study:

• To present an approach for combining evidence-based therapies in patients with HF with reduced ejection fraction (HFrEF).
• To review strategies for optimizing the management of common comorbidities in HF patients.
• To highlight prescription and nonprescription medications to avoid or use with caution in HF.

Main Methods:

• Literature review of evidence-based therapies for HFrEF.
• Analysis of common comorbidities and their therapeutic challenges in HF.
• Identification of potentially harmful medications (prescription and nonprescription) in HF management.

Main Results:

• An integrated approach for evidence-based therapy in HFrEF is outlined.
• Strategies for managing prevalent comorbidities in HF are discussed.
• Key medications requiring caution or avoidance in HF patients are identified.

Conclusions:

• Optimizing medication regimens in HF requires a comprehensive approach addressing HFrEF, comorbidities, and nonprescription drug interactions.
• Careful selection and monitoring of all medications are crucial for safe and effective HF management.
• This review provides a framework for clinicians to navigate complex polypharmacy in HF patients.