چکیده (انگلیسی):

Background:Polypharmacy is often considered suggestive of suboptimal prescribing, and is associated with
adverse outcomes. It is particularly common in the context of cardiovascular disease, but it is unclear whether
prescribing of multiple cardiovascular medicines, which may be entirely appropriate and consistent with clinical
guidance, is associated with adverse outcome. The aim of this study was to assess the relationship between
number of prescribed cardiovascular medicines and unplanned non-cardiovascular hospital admissions.
Methods:A retrospective cohort analysis of 180,815 adult patients was conducted using Scottish primary care
data linked to hospital discharge data. Patients were followed up for one year for the outcome of unplanned
non-cardiovascular hospital admission. The association between number of prescribed cardiovascular medicines
and hospitalisation was modelled using logistic regression, adjusting for key confounding factors including
cardiovascular and non-cardiovascular morbidity and non-cardiovascular prescribing.
Results:25.4% patients were prescribed≥1 cardiovascular medicine, and 5.7% were prescribed≥5. At least one
unplanned non-cardiovascular admission was experienced by 4.2% of patients. Admissions were more common in
patients receiving multiple cardiovascular medicines (6.4% of patients prescribed 5 or 6 cardiovascular medicines)
compared with those prescribed none (3.5%). However, after adjusting for key confounders, cardiovascular
prescribing was associated with fewer non-cardiovascular admissions (OR 0.66 for 5 or 6 vs. no cardiovascular
medicines, 95% CI 0.57-0.75).
Conclusions:We found no evidence that increasing numbers of cardiovascular medicines were associated with an
increased risk of unplanned non-cardiovascular hospitalisation, following adjustment for confounding. Assumptions
that polypharmacy is hazardous and represents poor care should be moderated in the context of cardiovascular
disease.