Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure.
Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure.
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DOI：
10.1186/s12872-023-03401-w
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发表时间：
2023-07-26
影响因子：
2.1
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中科院分区：
文献类型：
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因心力衰竭住院的老年人在出院后有跌倒的危险。导致跌倒的一个可改变因素是增加跌倒风险的药物（frid）。然而，因心衰住院的老年人中frid的患病率尚不清楚。我们描述了FRID使用的模式，并检查了FRID高负担的预测因素。我们使用了2003-2007年间招募的全国卒中地理和种族差异的双种族原因研究（REGARDS）。我们纳入了2003-2017年HF住院后存活出院年龄≥65岁的REGARDS参与者。我们从HF住院的图表抽象中确定入院和出院时的frid——心血管（CV）和非心血管（non-CV）药物。我们通过具有稳健标准误差的修正泊松回归检查了出院时高FRID负担的预测因子。在676家医院住院的1147名参与者中（46.5%为女性，平均年龄77.6岁），94%在入院时至少服用1次FRID， 99%在出院时至少服用1次FRID。入院时CV frid的患病率为92%，出院时为98%，入院和出院时非CV frid的患病率为32%。入院时（88%）和出院时（93%）最常见的CV FRID是抗高血压药；最常见的药物是受体阻滞剂（入院时61%，出院时75%），血管紧张素转换酶抑制剂（36%对42%）和钙通道阻滞剂（32%对28%）。循环利尿剂的患病率变化最大(53%对72%)。超过一半的队列患者（54%）有较高的FRID负担（医疗保健研究与质量机构（AHRQ）评分≥6），表明出院后跌倒风险较高。在多变量泊松回归分析中，与出院时高FRID负担密切相关的因素包括高血压（PR: 1.41, 95% CI: 1.20, 1.65）、情绪障碍（PR: 1.24, 95% CI: 1.10, 1.38）和过度用药（PR: 1.88, 95% CI: 1.64, 2.14）。在因心衰住院的老年人中，FRID的使用几乎是普遍的；超过一半的患者出院时FRID负担高。需要进一步的工作来指导一个常见的临床难题，即治疗心衰的指南适应症可能会增加跌倒的风险。在线版本包含补充材料，可在10.1186/s12872-023-03401-w获得。
Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden. We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003–2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003–2017. We determined FRIDs –cardiovascular (CV) and non-cardiovascular (non-CV) medications – at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors. Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14). FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls. The online version contains supplementary material available at 10.1186/s12872-023-03401-w.
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影响因子：
24
作者：
Gorodeski EZ;Goyal P;Hummel SL;Krishnaswami A;Goodlin SJ;Hart LL;Forman DE;Wenger NK;Kirkpatrick JN;Alexander KP;Geriatric Cardiology Section Leadership Council, American College of Cardiology
通讯作者：
Geriatric Cardiology Section Leadership Council, American College of Cardiology
影响因子：
4.1
作者：
Dyer SM;Crotty M;Fairhall N;Magaziner J;Beaupre LA;Cameron ID;Sherrington C;Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
通讯作者：
Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
影响因子：
2.9
作者：
Lee J;Negm A;Peters R;Wong EKC;Holbrook A
通讯作者：
Holbrook A
影响因子：
6
作者：
Denfeld, Quin E.;Goodlin, Sarah;Winters-Stone, Kerri
通讯作者：
Winters-Stone, Kerri
DOI：
10.1111/j.1532-5415.2008.02150.x
发表时间：
2009-03-01
影响因子：
6.3
作者：
Lee, Pearl G.;Cigolle, Christine;Blaum, Caroline
通讯作者：
Blaum, Caroline