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JFSF Vol 9, No 1, March 2024, p.51-65

doi: 10.22540/JFSF-09-051


Review Article

What is the association of polypharmacy with frailty in heart failure? A systematic review and meta-analysis

Konstantinos Prokopidis1, Giuseppe Dario Testa2, Nicola Veronese3, Yannis Dionyssiotis4, Joseph McLean5, Lauren E. Walker6,7, Rajiv Sankaranarayanan7,8,9

  1. Department of Musculoskeletal Science & Ageing, University of Liverpool, Liverpool, United Kingdom
  2. Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
  3. Unit of Geriatrics, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
  4. 2nd Physical Medicine and Rehabilitation Department, National Rehabilitation Center EKA, Athens, Greece
  5. Androlabs, London, United Kingdom
  6. Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  7. Department of Pharmacology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
  8. Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
  9. Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom

Keywords: Heart failure, Frailty, Polypharmacy, Medications, PIM


This systematic review and meta-analysis aimed to explore the differences in the number of prescribed medications and polypharmacy risk between patients with heart failure (HF) and frailty vs. those with HF but without frailty. Eligible studies included observational or experimental studies in patients aged ≥50 years. Thirteen studies met the criteria and were included in the final analysis. Patients with frailty and HF exhibited a higher risk of polypharmacy (OR: 1.87, 95% CI 1.72 - 2.04, I2 = 0%, P < 0.01) compared to those without frailty. Results remained significant after adjusting for comorbidity status. Additionally, patients with frailty and HF were prescribed more medications compared to those without (k = 6; MD: 1.43, 95% CI 0.31 - 2.55, I2 = 94%, P = 0.01), with a high degree of heterogeneity. However, results were non-significant after adjustment for comorbidity status. Patients with HF and frailty have a higher need of polypharmacy compared to those without frailty, which may increase the risk of potentially inappropriate medications (PIM). Investigating the real-world prevalence of PIM may support clinicians in their routine assessment as part of a comprehensive management strategy in patients with HF and frailty
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