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Published on: February 26, 2013
Definition of Polypharmacy in Atrial Fibrillation and Atrial Flutter: A Scoping Review
Ali Murra1, Akhil Mahant2, Lorraine Porcello3
1Department of Internal Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Cardiology Research
|July 29, 2026
Summary
Polypharmacy definitions for atrial fibrillation (AF) and atrial flutter (AFL) lack consistency. A threshold of five medications is common but not clinically meaningful; a higher threshold or medication review is recommended.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Polypharmacy, the use of multiple medications, lacks a standardized definition, with thresholds varying widely (4-15 medications).
- It is particularly prevalent in patients with atrial fibrillation (AF) and atrial flutter (AFL) due to comorbidities, increasing risks of adverse events.
- These risks include bleeding, falls, drug interactions, and medication non-adherence.
Purpose of the Study:
- To review definitions of polypharmacy in AF and AFL.
- To examine the clinical consequences associated with these definitions.
- To summarize strategies for preventing polypharmacy in this patient population.
Main Methods:
- A comprehensive literature search was conducted across five databases.
- Articles defining polypharmacy in adult patients with AF or AFL were included.
- A protocol was prospectively registered on PROSPERO (CRD420251135482).
Main Results:
- Of 109 articles, 96% focused on AF, and none focused solely on AFL.
- Most articles (96%) used quantitative definitions, with five or more medications being the most common (51%).
- The common definition of five medications is not clinically meaningful for AF/AFL patients.
Conclusions:
- There is ongoing debate regarding polypharmacy definitions in AF and AFL.
- A higher numeric threshold (≥10 medications) may be more appropriate, aligning with other cardiovascular conditions.
- Continuous medication assessment to balance benefits and risks is crucial, irrespective of the definition used.
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