Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
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Review

Volume 17, Number 4, August 2026, pages 249-266

Definition of Polypharmacy in Atrial Fibrillation and Atrial Flutter: A Scoping Review

Figures

↓  Figure 1. Flow diagram for process of literature search, screening, inclusion, and exclusion of articles.
Figure 1.
↓  Figure 2. Pie chart outlining various definitions of polypharmacy extracted.
Figure 2.

Table

↓  Table 1. Articles Identified That Included the Definition of Polypharmacy in AF/AFL
 
AuthorYearCountryArticle typeArrhythmiaClinical contextDefinition of polypharmacy used in AF/AFL
AF: atrial fibrillation; AFL: atrial flutter; ED: emergency department; MPI: Multidimensional Prognostic Index; MRCI: Medication Regimen Complexity Index; OAC: oral anticoagulant.
Amrouch et al [22]2023MultipleReviewAFMultiple≥ 2 drugs
Chen et al [27]2020USARetrospectiveAFMultiplePolypharmacy: ≥ 5 concurrently active medication prescription; substantial polypharmacy: ≥ 10 active prescriptions
Corica et al [65]2025MultipleAnalysisAFMultiple≥ 5 drugs
Guo et al [18]2022ChinaCross-sectionalAFMultiple≥ 5 long-term prescription medications
Harada [66]2023JapanAnalysisAFMultiple≥ 5 medications
Koziel et al [5]2020Balkan countriesAnalysisAFMultiple≥ 5 prescription drugs
Grymonprez et al [50]2024BelgiumProspectiveAFMultiple≥ 5 prescription medications
Liu et al [67]2025MultipleAnalysisAFOutpatient≥ 5 prescription medications
Ng et al [21]2025MultipleAnalysisAFInpatientNo explicit definitions, assessed as one of the eight individual domains of the MPI
Amrouch et al [68]2025MultipleReviewAFMultipleNot defined autonomously
Alberts et al [69]2025USARetrospectiveAFMultiple1–4 medications, 5–9 medications, and ≥ 10 medications
Zheng et al [70]2025MultipleAnalysisAFMultipleNot defined autonomously
Weng et al [71]2024USARetrospectiveAFOutpatient> 5 medications
Liu et al [72]2024ChinaProspectiveAFInpatient≥ 7 prescribed drugs
Catalaniet al [73]2024ItalyProspectiveAFMultiple≥ 5 medications
Goodman et al [74]2024MultipleReviewAFMultiple≥ 5 medications
Yamamoto et al [75]2024JapanAnalysisAFMultiple≥ 5 drugs
De Vincentis et al [76]2024ItalyAnalysisAFInpatient≥ 5 medications
Salmasi et al [77]2024CanadaRetrospectiveAFMultiple≥ 5 medications not including OAC
Corica et al [78]2024ItalyReviewAFMultiple≥ 5 drugs
Bischofet al [79]2024AustriaRetrospectiveAFED5 or more systemically active drugs
Amrouchet al [22]2024SwedenRetrospectiveAFMultiplePolypharmacy: 5–9 medications; excessive polypharmacy: ≥ 10 medications
Kim et al [28]2024KoreaRetrospectiveAFMultiple≥ 5 drugs
Shimazaki et al [14]2024JapanRetrospectiveAFInpatient≥ 6 medications
Shantsila et al [80]2024MultipleReviewAFMultiple≥ 5 drugs
Slater et al [81]2024United KingdomProspectiveAFOutpatient5–9 prescribed medications
Akao et al [82]2023JapanAnalysisAFMultiple≥ 5 medications
Verma et al [83]2023MultipleReviewAFMultiple≥ 5 prescribed medications
Zhang et al [84]2023ChinaProspectiveAFMultiple> 5 drugs
Catalani et al [85]2023ItalyProspectiveAFMultiple≥ 5 medications
Chen et al [86]2023USACross-sectionalAFOutpatient6–10 medications, ≥ 10 medications
Pierre-Louis et al [87]2023USAAnalysisAFOutpatient12–14, ≥ 15
Martinez-Montesinos et al [88]2023SpainProspectiveAFInpatient≥ 5 drugs
Kotalczyk et al [89]2022ChinaAnalysisAFOutpatient≥ 5 medications
Giugliano [90]2022USAReviewAFMultipleNot defined autonomously
Wang et al [91]2022ChinaAnalysisAFED≥ 5 medications
Romiti et al [92]2022MultipleAnalysisAFMultiple≥ 5 drugs
Caturano et al [93]2022SwedenReviewAFInpatientModerate polypharmacy: 5–9 medications; severe polypharmacy: > 9
Tsagkaris et al [19]2022GreeceAnalysisAFInpatient> 4 daily drugs
Yamashita et al [94]2022JapanAnalysisAFOutpatient≥ 5 medications
Honda et al [95]2022JapanRetrospectiveAFInpatient< 5, 6–9, ≥ 10 medications
Kotalczyk et al [96]2022ChinaAnalysisAFOutpatient≥ 5 medications
Alberts, M. et al [97]2022USARetrospectiveAFMultiple5–9, or ≥ 10 concurrent medications
Li et al [98]2022AustraliaRetrospectiveAFInpatient≥ 5 medications
Takamoto et al [99]2021JapanRetrospectiveAFOutpatient≥ 5 medications
Yokoyama et al [17]2021JapanRetrospectiveAFOutpatient≥ 5 prescribed drugs
Laliberte et al [100]2021USARetrospectiveAFOutpatient≥ 5 medications
Fujisawa et al [101]2021JapanRetrospectiveAFOutpatient≤ 3, 4–6, 7–9, ≥ 10
Berger et al [102]2021USARetrospectiveAFOutpatient5–9, ≥ 10 medications
Mongkhon et al [103]2021United KingdomProspectiveAFOutpatient≥ 5 medications
Millenaar et al [104]2021MultipleAnalysisAFMultiple5–8, ≥ 9
Lip et al [105]2021USAAnalysisAFMultiple≥ 6 medications
Grandone et al [106]2021ItalyReviewAFMultipleMultiple medication use
Kubas et al [107]2020MalaysiaRetrospectiveAFOutpatient≥ 5 medications
van den Dries et al [108]2020United KingdomRetrospectiveAFOutpatient≥ 5 drugs
Grymonprez et al [109]2020BelgiumReviewAFMultipleNot defined autonomously
Momo et al [110]2020JapanRetrospectiveAFNot defined> 6 medications
Mentias et al [15]2020USARetrospectiveAFNot definedLow polypharmacy: 3 generic medications; moderate polypharmacy: 4–8 medications; severe polypharmacy: ≥ 9 medications
Gallagher et al [29]2020AustraliaReviewAFMultipleNot defined autonomously
Proietti et al [111]2020USAAnalysisAFInpatient≥ 5 drugs
Harskamp et al [112]2019USAAnalysisAFMultiple≥ 5 drugs
Hohmann et al [113]2019GermanRetrospectiveAFMultiple≥ 7 substances
Kim et al [114]2019KoreaAnalysisAFMultiple≥ 5 drugs
Martinez et al [115]2019USARetrospectiveAFNot defined≥ 5 prescription medications; substantial polypharmacy: ≥ 10 medications
Rodriguez-Bernal et al [116]2018SpainRetrospectiveAFMultiple≥ 6 medications
Shaikh et al [117]2018AustraliaReviewAFMultiple≥ 5 drugs
Paciullo et al [118]2018ItalyAnalysisAFMultiple≥ 5 drugs
Pandya et al [119]2018AustraliaProspectiveAFInpatient> 4 medications
Sabbag et al [120]2018USAReviewAFMultipleThe concomitant use of multiple different drugs
Sommerauer et al [121]2017GermanyReviewAFMultiple≥ 5 drugs
Lobos-Bejarano et al [122]2017SpainAnalysisAFMultiple≥ 7 pills/day other than AVK
Brais et al [123]2017CanadaRetrospectiveAFInpatientAt least 5 prescribed medications
Mohammed et al [124]2017QatarRetrospectiveAFOutpatient≥ 6 medications
Mazzone et al [125]2016ItalyRetrospectiveAFInpatient≥ 5 drugs
Parks et al [126]2016USAReviewAFMultiplePrescription of multiple medications
Piccini et al [127]2016USAAnalysisAFMultiple0–4, 5–9, and ≥ 10 medications
Alexander et al [42]2019MultipleAnalysisAF and AFLMultiple≥ 5 medications
Alagiakrishnan et al [45]2019USAReviewAF and AFLMultiple≥ 5 medications
Proietti et al [128]2016MultipleAnalysisAFMultipleModerate polypharmacy: 5–7 medications; severe polypharmacy: 8+
Wang et al [129]2016AustraliaCross-sectionalAFOutpatientMinor polypharmacy: 5–9 medications; major polypharmacy ≥ 10 medications
Turagam et al [130]2015USAReviewAFMultipleIncreased usage of prescription and non-prescription medications
Granziera et al [131]2015USAReviewAFMultiple≥ 5 drugs or at least 1 drug with known interference with oral anticoagulant therapy
Sanders et al [132]2012USARetrospectiveAFED≥ 5 more prescription or nonprescription medications
Gasse et al [133]2005United KingdomProspectiveAFOutpatientMore than 4 prescription drugs including warfarin
Bai et al [134]2025ChinaCross-sectionalAFInpatientPolypharmacy: 5–9 drugs; excessive polypharmacy: ≥ 10 drugs
Corica et al [135]2024ChinaAnalysisAFMultiple≥ 5 drugs
Nicolau et al [136]2024USAReviewAFMultiple≥ 5 medications
Jaspers Focks et al [43]2016MultipleAnalysisAF and AFLMultiple≥ 5 drugs
Kim et al [137]2023KoreaRetrospectiveAFNot defined≥ 5 drugs
Chen [46]2016USAAnalysisAF and AFLMultiple≥ 5 prescription medications
Ãlvarez-Pinheiro et al [138]2022SpainRetrospectiveAFNot definedPolypharmacy: ≥ 5 drugs; extreme polypharmacy: ≥ 10 drugs
Amrouch et al [139]2022SwedenAnalysisAFMultipleMild polypharmacy: 5–10 drugs; high polypharmacy: >10 drugs
Boriani et al [140]2022EuropeAnalysisAFMultiple≥ 5 drugs
Grymonprez et al [141]2022BelgiumProspectiveAFMultiplePolypharmacy was 5–9, hyperpolypharmacy ≥ 10 drugs
Stefil, M. et al [142]2022MultipleAnalysisAFMultiple≥ 5 medications
Voß et al [143]2021EuropeRetrospectiveAFNot defined≥ 5 medications
Button et al [144]2021MultipleAnalysisAFMultiple≥ 3 baseline medications
Alam et al [145]2020USARetrospectiveAFMultiple≥ 5 active prescriptions
Marinelli et al [146]2019ItalyProspectiveAFInpatient≥ 5 drugs
Shantha et al [147]2019AustraliaAnalysisAFMultipleModerate polypharmacy: 5–9 medications; severe polypharmacy: > 9 medications
La Rovere & Traversi [148]2018USARetrospectiveAFNot defined0–5, 6–10, ≥ 11 unique active ingredients
Nissen Bonde et al [149]2018MultipleReviewAFMultiple≥ 5 medications
Hung et al [150]2016DenmarkRetrospectiveAFMultiple≥ 5 medications
Hughes & Lip [151]2013TaiwanCross-sectionalAFInpatient> 4 kinds of drugs
Bolt et al [152]2007MultipleReviewAFMultipleNot defined autonomously
Liu et al [153]2023CanadaCross-sectionalAFOutpatient≥ 5 medications
Sa et al [154]2023ChinaProspectiveAFInpatient≥ 7 medications
Chen et al [20]2023BrazilCross-sectionalAFOutpatient5–9 medications
Dobrica et al [155]2023ChinaRetrospectiveAFMultipleNot defined, used MRCI instead
Amrouch et al [22]2020RomaniaRetrospectiveAFInpatient≥ 5 medications