The term polypharmacy describes the practice of prescribing multiple medicines for one individual. This practice has been increasing over the past decade and is most likely attributable to a growing ageing population who have an increased number of long-term conditions. There is some evidence to suggest that polypharmacy may be beneficial; however, other researchers report that this practice is associated with harmful consequences, including falls, hospitalisations and death.
Several studies have been conducted to determine whether polypharmacy is associated with certain medications or specific long-term conditions. Findings showed that medications which act on the heart are most commonly prescribed in polypharmacy regimens, in addition to establishing an association between polypharmacy and heart conditions.
This study will focus on one heart condition, atrial fibrillation (AF). The condition currently affects 1.4 million adults living in England and like polypharmacy, the incidence of AF increases with age. If left untreated or managed inappropriately, AF can cause strokes, heart failure and death. The aim of this study is to determine whether polypharmacy is associated with death or strokes in patients who have been newly diagnosed with AF.
This prognostic cohort study has been designed to determine whether polypharmacy is associated with death or ischemic stroke among individuals who have been newly diagnosed with atrial fibrillation. Only data labelled as acceptable by CPRD will be used in this study. All patients with a recorded diagnosis of AF will be identified. The earliest record of AF will be defined as the index date. Details of prescribed medications, issued within the first three months of the index date, will be obtained for each patient. Using this data, patients will be allocated into one of the following three groups: unexposed at study entry (1-4 different prescribed medicines), exposed to polypharmacy at study entry (5-9 different prescribed medicines) or exposed to hyper-polypharmacy at study entry (?10 different prescribed medicines). Patients will be followed until the occurrence of a study outcome (i.e. death or ischemic stroke) or until the end of follow-up (10 years maximum). Comparisons will be made between the incidence of death and ischemic stroke in the exposed, compared to the unexposed groups. All models will be adjusted for known prognostic factors, which will be measured in the two years prior to index date.
Incidence of death during follow up period
Incidence of ischemic stroke during follow up period
Martin Frisher - Chief Investigator - Keele University
Natasha Slater - Corresponding Applicant - Keele University
Simon White - Collaborator - Keele University
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation