Clinical Outcomes in Patients with Chronic Limb-Threatening Ischemia with or Without Hyperpolypharmacy After...

Polypharmacy (PP) or hyperpolypharmacy (HP) in elderly patients has been associated with poor prognosis and cardiovascular events due to side effects and drug interactions. Patients with chronic limb-threatening ischemia (CLTI) have many comorbidities that may need multiple drugs. The purpose of this study is to evaluate clinical outcomes in these patients with or without HP.

Patients who underwent initial revascularization for CLTI between 2014 and 2022 at a single center were evaluated retrospectively. Comparisons were made between patients with no PP (< 5 prescription drugs) or PP (5-9 prescription drugs) (no hyperpolypharmacy [NHP] group) and HP (≥ 10 prescription drugs) (HP group) after revascularization. The primary outcomes were overall survival (OS) and risk factors affecting survival.

There were 193 patients (21 [5%] without PP and 172 [41%] with PP) in the NHP group (46%) and 224 (53%) in the HP group. The median number of drugs was 10 (7-13). During a mean follow-up period of 32.0 ± 28.3 months, 182 patients died. Using the Kaplan-Meier method, the 1-year, 3-year, and 5-year OS rates of 79.9%, 50.0%, and 35.1%, respectively, in the HP group were significantly lower than those in the NHP group (P < 0.001). Freedom from cardiovascular death (P < 0.001) and limb salvage (P = 0.010) were also lower in the HP group. In multivariate analysis, death was independently associated with HP (hazard ratio, 1.60; 95% confidence interval, 1.14-2.25; P = 0.007).

HP in patients with CLTI after revascularization was negatively associated with OS, freedom from cardiovascular death, and limb salvage.