Polypharmacy at the admission and risk of in-hospital death in elderly patients with acute heart failure

Background: Polypharmacy and multimorbidity affect the prog-nosis in several acute pathologies. We aimed to evaluate ifpolypharmacy at the admission could affect AHF prognosis in acohort of elderly patients.Materials and Methods:We enrolled AHF patients, investigatingage, sex, in-hospital mortality, polypharmacy (defined as the con-temporary use of 5 or more medications) and presence of comor-bidities. We then prepared a logistic regression containing age, sexand all the comorbidities as predictors and in-hospital mortalityas outcome. We then added polypharmacy in a second model. Weobtained two ROC curves predicting in-hospital mortality for AHFand compared them.Results:Mean age was 82.56 (±8,92), females representing53.7% of the sample. In-hospital mortality was 13%. The firstmodel, containing 16 comorbidities, age and sex as predictors,showed excellent predictive value (AUC: 0.931; 95% CI: 0.864-0.971; p<0.0001). Adding polypharmacy increased significantlythe power of prediction (AUC: 0.954; 95% CI: 0.895-0.986;p<0.0001), and the difference between curves resulted significant(p=0.05).Discussion:In this sample of elderly patients affected by AHF, weobserved that age, sex, comorbidities and polypharmacy at theadmission account for a large part of the observed in-hospitalmortality. The physician should be aware that polypharmacy at theadmission carries an additional risk of in-hospital death in elderlypatients affected by AHF.