Adults with heart failure with reduced ejection fraction (HFrEF) who took a "polypill" combining three guideline-recommended medications had improved heart function, better quality of life, fewer hospitalizations, and greater medication adherence compared to those taking the same medications as separate pills, according to late-breaking research presented today at the American Heart Association’s Scientific Sessions 2025. The findings, which are considered preliminary until published in a peer-reviewed journal, highlight a potential strategy to simplify treatment regimens and improve outcomes in this high-risk population.
The trial included 212 adults with HFrEF who were not receiving optimal guideline-directed therapy. Participants were randomly assigned to either a polypill containing metoprolol succinate, spironolactone, and empagliflozin taken once daily, or to enhanced standard care with the same medications taken as individual pills. All participants also took sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor dosed twice daily. After six months, those in the polypill group showed a 3.4% higher absolute left ventricular ejection fraction (LVEF) compared to the standard care group, indicating improved heart function. Additionally, the polypill group had a 60% reduction in heart failure-related hospitalizations and emergency room visits, and reported higher quality of life scores (72 vs. 63 on a 100-point scale).
"In recent decades, there have been important, effective treatment advances for patients with heart failure, however, use of these treatments remains disappointingly low, with only 15% of patients receiving all guideline-recommended therapies at any dose for heart failure after hospitalization," said study author Ambarish Pandey, M.D., M.S., FAHA, an associate professor of internal medicine at UT Southwestern Medical Center. "In our study, we focused on socially disadvantaged populations to demonstrate the positive impact of an easier-to-follow medication regimen of only one pill vs. three pills daily, and we found significant improvements even after six months."
Medication adherence, assessed through blood tests at six months, was significantly higher in the polypill group, with 79% of patients having detectable levels of metoprolol or spironolactone compared to only 54% in the standard care group. The study enrolled participants from Parkland Health and Hospital System, UT Southwestern Medical Center, and the William F. Clements University Hospital in Dallas. The median age was 54 years, 22% were female, 54% identified as Black, and 33% were Hispanic. Notably, 68% had no health insurance or county-sponsored coverage, 42% reported food insecurity, and 32% reported housing instability.
"Our findings provide the first evidence that a polypill approach could be effective for our patients with heart failure," Pandey added. The researchers plan further studies to evaluate broader implementation of this strategy. According to the American Heart Association, heart failure affects about 6.7 million U.S. adults, with numbers expected to rise above 8 million by 2030. This study offers a promising avenue to simplify treatment and improve outcomes, especially in underserved populations.
For more information on heart failure, visit the American Heart Association's heart failure page. The full abstract is available in the Scientific Sessions 2025 Online Program Planner.
