BackgroundPolypharmacy is highly prevalent in elderly people with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly patients with AF remains unaddressed.Methods and ResultsWe studied 338 810 AF patients ≥75 years of age enrolled in the MarketScan Medicare Supplemental database in 2007–2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis (defined by the presence of International Classification of Diseases, Ninth Revision, Clinical Modification [ICD‐9‐CM] codes) based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular end points (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient, and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular end points and the interaction between polypharmacy and AF treatments in relation to cardiovascular end points. Prevalence of polypharmacy was 52%. Patients with polypharmacy had increased risk of major bleeding (hazard ratio [HR], 1.16; 95% CI, 1.12–1.20) and heart failure (HR, 1.33; 95% CI, 1.29–1.36) but not ischemic stroke (HR, 0.96; 95% CI, 0.92–1.00), compared with those not receiving polypharmacy. Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. Rhythm control (versus rate control) was more effective in preventing heart failure hospitalization in patients not receiving polypharmacy (HR, 0.87; 95% CI, 0.76–0.99) than among those with polypharmacy (HR, 0.98; 95% CI, 0.91–1.07; P=0.02 for interaction).ConclusionPolypharmacy is common among patients ≥75 with AF, is associated with adverse outcomes, and may modify the effectiveness of AF treatments. Optimizing management of polypharmacy in AF patients ≥75 may lead to improved outcomes.

中文翻译：

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≥75 名心房颤动患者的多种药物治疗、不良结局和治疗效果。

背景多种药物在患有包括心房颤动在内的慢性病的老年人中非常普遍。自动对焦）。多药治疗对老年痴呆患者不良结局和治疗效果的影响自动对焦 仍未解决。方法和结果我们研究了 338 810 自动对焦≥75 岁的患者在 2007-2015 年登记在 MarketScan Medicare 补充数据库中。多药治疗被定义为 ≥5 个有效处方自动对焦基于门诊药房索赔的诊断（由国际疾病分类，第九版，临床修改[ ICD-9-CM ] 代码定义）。自动对焦治疗（口服抗凝、节律和心率控制）和心血管终点（缺血性中风、出血、心力衰竭）是根据住院、门诊和药房索赔定义的。多变量 Cox 模型用于估计多药治疗与心血管终点的关联以及多药治疗与自动对焦与心血管终点相关的治疗。多种药物的流行率为 52%。服用多种药物的患者发生大出血的风险增加（风险比 [人力资源], 1.16; 95% CI, 1.12–1.20) 和心力衰竭 (人力资源, 1.33; 95%CI, 1.29–1.36) 但不是缺血性中风 (人力资源, 0.96; 95%CI, 0.92–1.00)，与未接受多种药物治疗的患者相比。多种药物状态并没有一致地改变口服抗凝剂的有效性。在未接受多种药物治疗的患者中，节律控制（相对于心率控制）在预防心力衰竭住院方面更有效（人力资源, 0.87; 95%CI, 0.76–0.99) 比使用多种药物的患者 (人力资源, 0.98; 95%CI, 0.91–1.07; P = 0.02（交互作用）。结论在≥75 岁的患者中，多药治疗很常见自动对焦, 与不良结果相关, 并可能改变自动对焦治疗。优化多药治疗管理自动对焦≥75 岁的患者可能会改善预后。