Key Points:
- Patients with heart failure with reduced ejection fraction (HFrEF) often face a high daily pill burden, contributing to poor adherence to guideline-directed medical therapy (GDMT).
- The POLY-HF study evaluated patient perspectives on a once-daily heart failure polypill containing metoprolol succinate, spironolactone, and empagliflozin.
- In a mixed-methods sub-study, a polypill strategy was found to be highly acceptable and perceived to improve adherence, particularly among socioeconomically disadvantaged and underrepresented populations.
- Participants ranked survival, reduced hospitalizations, and improved symptoms as top treatment goals; key barriers to adherence included pill burden and forgetfulness.
Despite proven benefits of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF), medication adherence remains a challenge, particularly among socially vulnerable populations. To address this, the ongoing POLY-HF trial is evaluating a fixed-dose combination polypill strategy to streamline care delivery. At the American Heart Association Scientific Sessions 2025, held in New Orleans, Louisiana, on November 10, Dr. Ambarish Pandey (UT Southwestern Medical Center, Dallas, TX) presented results from a nested mixed-methods sub-study that assessed patient and caregiver perspectives on the polypill strategy. The study is simultaneously published in Circulation.
The sub-study enrolled 36 patients and 5 caregivers following participation in the Phase II POLY-HF randomized trial. Participants were predominantly Black (53%) or Hispanic (39%), with 25% Spanish-speaking and a median age of 53 years. A majority (58%) reported taking six or more medications daily, and 50% acknowledged missing doses, primarily due to forgetting. Using standardized surveys and semi-structured focus groups, researchers explored attitudes toward the polypill and treatment priorities.
Quantitative data revealed that 89% of participants favored the polypill approach, and 83% believed it would help with adherence. Most (69%) ranked survival as their top treatment goal, followed by reducing symptoms and avoiding hospitalization.
Qualitative themes reinforced these findings: patients described a strong preference for regimen simplification and felt the polypill would reduce stress, increase peace of mind, and improve consistency with medication intake. Caregivers also viewed the strategy favorably, citing reduced complexity in organizing medications. Concerns included pill size, fixed-dose rigidity, and uncertainty about individual drug components. Trust in healthcare providers and institutional support emerged as key facilitators for future adoption.
Dr. Pandey concluded: “This study shows that patients and caregivers, especially in communities burdened by healthcare disparities are enthusiastic about a polypill strategy. These findings support a patient-centered approach to implementation, with attention to size, cost, and language accessibility.”
The POLY-HF trial is funded by the National Institutes of Health (NIMHD R01MD017529, NIA R03AG067960), American Heart Association, Texas Health Resources Clinical Scholarship, and Gilead Sciences.
