Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments.
Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments.
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DOI：
10.3389/fphar.2020.611102
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发表时间：
2020
影响因子：
5.6
通讯作者：
MEREAFaPS Study group
中科院分区：
文献类型：
--
作者：
Crescioli G;Bettiol A;Bonaiuti R;Tuccori M;Rossi M;Capuano A;Pagani S;Spada G;Venegoni M;Vighi GD;Mannaioni G;Vannacci A;Lombardi N;MEREAFaPS Study group
背景：关于老年人心血管（CV）药物安全性的知识存在显著差距。在此背景下，我们的目的是根据不同年龄组确定与心血管药物相关的门诊患者药物不良事件（ADEs）导致急诊（ED）就诊的临床和药理学特征，并评估该人群中与ADEs相关的住院风险。方法：对meeafaps研究中涉及的94例ed在2007-2018年间收集的疑似ADEs报告进行了一项多中心回顾性研究。选择经历一次或多次心血管药物相关的不良事件导致急诊科就诊的老年患者。收集患者特征、疑似（ATC B级和C级）及伴随药物、ADE描述。老年患者被分为三个年龄组（65-74岁、75-84岁和≥85岁），并与成人（18-64岁）进行比较。使用Logistic回归分析来估计报告的优势比（RORs）， 95%置信区间（ci）的ade相关住院调整性别，存在两种或多种可疑药物，伴随药物和一种或多种合并症。结果：在老年人中，收集到16926例疑似与CV药物相关的ADE报告，其中6694例（39.5%）导致住院治疗。患者多为女性、白种人、中老年（75 ~ 84岁）。78.9%的患者仅使用一种可疑药物治疗，71.9%和47.1%的患者分别报告了合并用药和合并症。与成人相比，暴露于维生素K拮抗剂（1.29[1.09-1.52]和1.56[1.30-187]）、直接凝血酶抑制剂（3.41[1.44-8.08]和4.12[1.67-10.17]）、抗血小板剂（1.51[1.26-1.81]和2.09[1.71-2.57]）和β受体阻滞剂（1.89[1.38-2.59]和2.31[1.60-3.35]）的中老年和高龄患者住院风险显著更高。总的来说，肾素-血管紧张素系统抑制剂（1.32[1.04-1.68],1.65[1.32 - 2.06]和2.20[1.70-2.85]）、两种或两种以上的合用药物以及合用疾病的存在，住院风险更高。结论：我们的现实世界研究结果强调了心血管药物在意大利老年人群中的相关安全性。ED临床医生必须始终考虑到与老年人，特别是最年长的老年人使用心血管药物相关的住院风险较高，如抗心律失常药、β -阻滞剂、肾素-血管紧张素系统抑制剂、抗血小板和抗凝血药。
Background: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency department (ED) visits in the elderly Italian patients according to different age groups, and to evaluate the risk of hospitalization associated to ADEs in this population. Methods: A multicentre, retrospective study was performed on reports of suspected ADEs collected between 2007–2018 in 94 EDs involved in the MEREAFaPS Study. Elderly patients who experienced one or more CV medications-related ADEs leading to ED visit were selected. Patients’ characteristics, suspected (ATC classes B and C) and concomitant drugs, and ADE description were collected. Elderly patients were stratified into three age groups (65–74, 75–84, and ≥85 years) and compared to adults (18–64 years). Logistic regression analyses were used to estimate the reporting odds ratios (RORs) with 95% confidence intervals (CIs) of ADE-related hospitalization adjusting for sex, presence of two or more suspected drugs, concomitant drugs, and one or more comorbidities. Results: Among elderly, 16,926 reports of suspected ADE related to CV medications were collected, and 6,694 (39.5%) resulted in hospitalization. Patients were mostly female, Caucasians, and middle-old (75–84). 78.9% of patients were treated with only one suspected drug, and 71.9% and 47.1% reported concomitant medications and comorbidities, respectively. Compared to adults, risk of hospitalization was significantly higher for middle-old and oldest-old patients exposed to vitamin K antagonists (1.29 [1.09–1.52] and 1.56 [1.30–187]), direct thrombin inhibitors (3.41 [1.44–8.08] and 4.12 [1.67–10.17]), antiplatelets (1.51 [1.26–1.81] and 2.09 [1.71–2.57]), and beta-blockers (1.89 [1.38–2.59 and 2.31 [1.60–3.35]). Overall, a higher risk of hospitalization was observed for renin-angiotensin system inhibitors (1.32 [1.04–1.68], 1.65 [1.32–2.06], and 2.20 [1.70–2.85]), presence of two or more concomitant drugs, and concomitant conditions. Conclusion: Our real-world findings underline relevant safety aspects of CV medications in the elderly Italian population. ED clinicians must always consider the higher risk of hospitalization related to the use of CV drugs in elderly, particularly in oldest-old ones, for antiarrhythmics, beta-blocking agents, renin-angiotensin system inhibitors, antiplatelets, and anticoagulants.
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