Keramida Kalliopi, Savarese Gianluigi, Filippatos Gerasimos, Yusuf Salim
Cardiology Department, General Anti-Cancer, Oncological Hospital, Agios Savvas, Athens, Greece.
Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Heart Fail Rev. 2025 Sep 6. doi: 10.1007/s10741-025-10559-2.
Heart failure (HF) remains a global health challenge that imposes significant clinical and economic burden. Treatment adherence to guideline-directed medical therapy (GDMT) remains a major challenge in the management of HF, despite the availability of guideline-directed medical therapy (GDMT). Polypharmacy and regimen complexity contribute to poor adherence, particularly among older adults and in resource-limited settings. The polypill strategy, involving fixed-dose combinations of essential HF medications, has emerged as a potential solution to simplify treatment regimens, enhance adherence, and improve clinical outcomes. This review explores the potential of polypill therapy as a pragmatic strategy to simplify HF treatment and improve adherence. Drawing on its successful application in other cardiovascular diseases, we propose two implementation approaches for HF: early low-dose initiation for newly diagnosed patients or switching to a pre-specified dose polypill for stable, optimized patients. This review discusses formulations tailored to different HF phenotypes and highlights ongoing clinical trials assessing the efficacy and safety of the polypill in the HF setting. While the polypill approach offers promising benefits, i.e., improved adherence, affordability, and streamlined care, critical considerations regarding the selection of optimal drug components, identification and elimination of potential drug-drug interactions, the definition of appropriate flexible dose combinations, and patient-specific factors are crucial. Future research, particularly real-world clinical trials, is essential to comprehensively evaluate the efficacy, safety, and feasibility of polypill therapy in diverse HF patient populations, ensuring its responsible integration into clinical practice across diverse healthcare settings to mitigate the persistent burden of HF.
心力衰竭（HF）仍然是一项全球性的健康挑战，带来了巨大的临床和经济负担。尽管有指南指导的药物治疗（GDMT），但在HF管理中，坚持GDMT治疗仍然是一个主要挑战。多种药物联合使用和治疗方案的复杂性导致依从性差，尤其是在老年人和资源有限的环境中。包含HF基本药物固定剂量组合的复方制剂策略已成为简化治疗方案、提高依从性和改善临床结局的潜在解决方案。本综述探讨了复方制剂疗法作为简化HF治疗和提高依从性的实用策略的潜力。借鉴其在其他心血管疾病中的成功应用，我们为HF提出了两种实施方法：对新诊断患者早期低剂量起始治疗，或对病情稳定、已优化治疗的患者转换为预先指定剂量的复方制剂。本综述讨论了针对不同HF表型的制剂，并强调了正在进行的评估复方制剂在HF环境中的疗效和安全性的临床试验。虽然复方制剂方法提供了有前景的益处，即提高依从性、可负担性和简化护理，但关于最佳药物成分的选择、潜在药物相互作用的识别和消除、适当灵活剂量组合的定义以及患者特异性因素等关键考虑因素至关重要。未来的研究，尤其是真实世界的临床试验，对于全面评估复方制剂疗法在不同HF患者群体中的疗效、安全性和可行性至关重要，以确保其在不同医疗环境中合理融入临床实践，减轻HF持续存在的负担。
