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Polypharmacy and hyperpolypharmacy in elderly (≥ 65 years) pacemaker recipients: Prevalence and association with frailty, physical activity, adherence, and healthcare utilization in a prospective single-center study 

Miguel Costa, Natália António, Carolina Félix, Inês Jordão, Patrícia Paiva, Joana Guimarães, Diogo Fernandes, Lino Gonçalves, and Francisco Parente

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Volume 64 (2026) p. 335 - 345

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 7/2026 (335-345)

Miguel Costa¹#², Natália António¹#²#³, Carolina Félix¹#², Inês Jordão¹#², Patrícia Paiva¹#², Joana Guimarães³, Diogo Fernandes³, Lino Gonçalves³, and Francisco Parente¹

¹Clinical Pharmacology Unit, and ²Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, and ³Department of Cardiology, ULS Coimbra, E.P.E., Coimbra, Portugal
Objectives: To quantify polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs) in pacemaker recipients aged ≥ 65 years and to assess associations with frailty (FRAIL), physical activity (IPAQ), medication adherence (MAT), and healthcare utilization over 6 months.
Background: Polypharmacy is common in elderly patients with cardiac devices, but prospective data from European pacemaker clinics on frailty, physical activity, adherence, and prescribing quality are limited.
Materials and methods: Prospective, single-center observational study in a Portuguese tertiary pacemaker outpatient clinic (n = 104). Participants (≥ 65 years) were assessed at enrolment and at 3 and 6 months. FRAIL, IPAQ, and MAT were recorded at each timepoint. Healthcare utilization was defined as emergency department visits and/or hospital admissions. STOPP/START v3 was applied descriptively at 6 months.
Results: Mean age was 79.1 ± 7.5 years; 69.2% were men. Polypharmacy and hyperpolypharmacy were present in 49.0% and 38.5% at enrolment and 47.5% and 43.4% at 6 months. A higher number of chronic medications was associated with higher FRAIL scores, lower IPAQ scores and more frequent healthcare utilization, whereas MAT scores remained uniformly high. Cardiovascular drugs, diuretics, and proton-pump inhibitors (PPIs) were the most frequently used classes. STOPP/START identified potentially inappropriate medications (notably PPIs and benzodiazepines) and prescribing omissions according to START (notably cardiovascular therapies).
Conclusion: Polypharmacy and hyperpolypharmacy are frequent and persistent in elderly pacemaker recipients and are associated with frailty, lower physical activity and higher healthcare utilization. Structured medication review during routine follow-up may help identify PIMs and PPOs and optimize pharmacotherapy.Correspondence to:
Miguel Filipe Oliva Nogueira da Costa, MD
Praceta Professor Mota Pinto
3004-561 Coimbra, Portugal
Email: [email protected]

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