Attitudes towards using single-pill combination (polypill) therapy in heart failure: patients' and physicians'...

Single-pill combinations (SPC, polypills) have proven effective in cardiovascular areas, yet no such therapy exists for patients with heart failure (HF) despite substantial polypharmacy and pill burden in this population. Simplifying treatment through an HF-specific SPC containing key guideline-directed medical therapy (GDMT) components could improve adherence and outcomes.

Two prospective, electronic surveys were conducted between June and October 2025 to assess real-world attitudes towards a polypill in HF with ejection fraction ≤50%. The physician-oriented survey (22 questions) was distributed internationally and explored GDMT practices, perceived needs, barriers, and potential preferred composition of an HF dedicated SPC. The patient-oriented survey (11 questions) explored medication burden, adherence, and perceptions of a potential polypill use.

A total of 250 physicians and 126 patients participated. Among physicians, 77% reported a clear need for strategies to simplify GDMT optimisation in HFrEF, with cost (66%) and polypharmacy (54%) being selected as the most frequent barriers. Nearly all physicians (95%) recognized a real clinical need for an HF-specific SPC, and most perceived it as clinically useful (88%), logistically feasible (76%), and acceptable to patients (94%). Approximately 48% of physicians declared that they would use it regularly, and another 49% would use it in selected patients. The preferred composition of HF-specific SPC included a beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor (61.2%).Among patients, polypharmacy was common (70% taking ≥6 drugs daily), and 75% admitted to occasional non-adherence. Most responders (82%) would support a solution that reduces the pill burden, and 83% would take an HF-specific SCP if offered, particularly if there is no extra cost.

Both physicians and patients showed strong openness and willingness towards an HF-specific SPC, supporting further development and evaluation of HF-specific polypill strategies.