关键词: 老年人, 心力衰竭, 循证护理学, 多重用药, 用药管理, 证据总结

Abstract: Objective To summarize the best evidence for polypharmacy management in elderly patients with chronic heart failure(CHF), and to provide a basis for healthcare professionals to assess polypharmacy in this population and standardize medication management practices. Methods Following the 6S model, evidences on polypharmacy management were retrieved from databases including UpToDate, BMJ Best Practice, JBI Evidence-Based Practice Database, the National Institute for Health and Care Excellence (NICE) guidelines website, Medlive, Cochrane Library, Embase, PubMed, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, and the Chinese Biomedical Literature Database. The search timeframe spanned from the inception of each database to March 2025. The PIPOST model was adopted to clarify evidence-based questions, and the included literature types comprised clinical guidelines, evidence summaries, systematic reviews, expert consensus statements, and clinical decision-making documents. Two researchers independently conducted literature screening, quality assessment, and evidence extraction, with any discrepancies resolved through consultation with a third researcher. Finally, the extracteds evidences were thematically categorized and synthesized, and the JBI Evidence Pre-grading System (2014 version) was applied to grade the levels of evidences. Results A total of 11 articles were included, from which 29 best-practice recommendations were synthesized. The innovation of this summary lies in the development of a comprehensive management framework encompassing assessment, prescribing, intervention, follow-up, and education of the patients. Central to this framework is the proposal of a “tiered collaborative” implementation pathway tailored to China’s current healthcare resource landscape. The evidence particularly highlights the value of interprofessional collaboration, the development of locally adapted assessment tools, and the pivotal coordinating role of nurses in continuity of care. Conclusions The evidence synthesized in this study can be applied in clinical practice by selecting the most appropriate evidence in combination with hospital context, clinical scenarios, and individual patient characteristics. This approach aims to standardize polypharmacy management practices and ensure medication safety.   

Key words: aged, heart failure, evidence-based nursing, polypharmacy, medication management, evidence summary