Addressing Multimorbidity and Polypharmacy in Individuals With Atrial Fibrillation

  • Fahad Shaikh
  • Lachlan B. Pasch
  • Phillip J. Newton
  • Beata V. Bajorek
  • Caleb Ferguson
Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing


Purpose of Review

The objectives of this review were to (1) discuss how multimorbidity and polypharmacy contributes to the complexity of management among individuals with AF and (2) identify any interventions to manage polypharmacy in relation to AF.

Recent Findings

Based on the four landmark clinical trials of novel anticoagulants, the most common comorbidities with AF are hypertension, heart failure, diabetes, stroke and myocardial infarction. Polypharmacy was also found prevalent in 76.5% of patients with AF, with a median of six drugs per patient. Despite the consequences of polypharmacy in AF, there is very little evidence-based intervention designed to manage it. Hence, there is a need for further research to examine interventions to manage polypharmacy in relation to AF.


Atrial fibrillation (AF) is the most common type of cardiac arrhythmia requiring treatment in adults. Due to the structural and/or electrophysiological abnormalities that occur in AF, patients are managed through the use of prophylactic anticoagulant and rate and/or rhythm control medications. However, these medications are considered high risk and can increase the chances of medication misadventure. Additionally, AF rarely occurs in isolation and is known to coexist with multiple other medical comorbidities, i.e. multimorbidity. This also increases the number of medications, i.e. polypharmacy and pill burden which results in treatment non-compliance to prescribed therapy.


Atrial fibrillation Multimorbidity Polypharmacy Anticoagulation Warfarin 



Dr. Caleb Ferguson received funding through the University of Technology Sydney Chancellor’s Postdoctoral Research Fellowship scheme (2016-2017).

Funding Sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of Interest

Fahad Shaikh, Lachlan B. Pasch, Phillip J. Newton, Beata V. Bajorek, and Caleb Ferguson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Fahad Shaikh
    • 1
  • Lachlan B. Pasch
    • 2
  • Phillip J. Newton
    • 2
  • Beata V. Bajorek
    • 1
  • Caleb Ferguson
    • 2
  1. 1.Discipline of Pharmacy, Graduate School of HealthUniversity of Technology SydneyUltimoAustralia
  2. 2.Western Sydney Nursing and Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown HospitalBlacktownAustralia

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