COMPETENCY IN MEDICAL KNOWLEDGE: Patients with HFrEF who are on polypharmacy (ie, use of ≥5 non-HF medications) are
Original ResearchPolypharmacy and Optimization of Guideline-Directed Medical Therapy in Heart Failure: The GUIDE-IT Trial
Central Illustration
Section snippets
Study design and participants
Data for the current analysis were obtained from the National Institute of Health Biologic Specimen and Data Repository Coordinating Center. The design and primary results of the GUIDE-IT trial have been published previously.14,15 In brief, the GUIDE-IT trial, which was conducted between 2013 and 2016, enrolled 894 patients with HFrEF (left ventricular ejection fraction of <40%) and randomized them in a 1:1 fashion to either usual care or NT-proBNP–guided therapy. Patients in the usual care arm
Results
Among the 894 participants enrolled in the GUIDE-IT trial, 891 had data on baseline medication count and were included in the current analysis. At baseline, 604 (67.8%) and 30 (3.4%) participants were prescribed >5 and >10 total medications, respectively, and 79 (8.9%) were on optimal GDMT. Among non-GDMT medications, the median was 4 (IQR: 3-6), with 414 (46.5%) prescribed ≥5 non-GDMT medications at baseline and identified as being on polypharmacy. The most used non-GDMT medications were
Discussion
This post hoc analysis of the GUIDE-IT trial identified several key findings. First, non-GDMT polypharmacy is highly prevalent among patients with HFrEF, with >46% on 5 or more non-GDMT medications. Second, although the odds of achieving optimal GDMT increased over time in the overall cohort, they were modified by the baseline burden of polypharmacy such that those with a higher number of non-GDMT medications had a lower probability of reaching optimal GDMT. Finally, increasing count of
Conclusions
The findings of this study suggest that patients with HFrEF who are on non-GDMT polypharmacy are more likely to experience underuse of GDMT despite being at higher risk for adverse clinical outcomes. Future studies are needed to determine whether the implementation of multidisciplinary interventions to lower the polypharmacy burden may improve GDMT uptake among patients with HFrEF.
Funding Support and Author Disclosures
Dr Pandey has received research support from the National Institute on Aging GEMSSTAR grant (1R03AG067960-01) and the National Institute on Minority Health and Disparities (R01MD017529); grant funding from Applied Therapeutics and Gilead Sciences; honoraria outside of the present study as an advisor/consultant for Tricog Health Inc, Lilly USA, Rivus, Cytokinetics, and Roche Diagnostics; nonfinancial support from Pfizer and Merck; and is a consultant for Palomarin Inc with stock compensation. Dr
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