Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure.
Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure.
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DOI：
10.1097/jcn.0000000000000885
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发表时间：
2023-01-01
影响因子：
2
通讯作者：
Kimura, Takeshi
中科院分区：
文献类型：
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作者：
Ozasa, Neiko;Kato, Takao;Morimoto, Takeshi;Yaku, Hidenori;Yamamoto, Erika;Inuzuka, Yasutaka;Tamaki, Yodo;Kitai, Takeshi;Washida, Koichi;Seko, Yuta;Yoshikawa, Yusuke;Sato, Yukihito;Motoki, Hirohiko;Kuwahara, Koichiro;Kimura, Takeshi
多重用药是急性失代偿性心力衰竭（ADHF）患者的常见问题，通常伴有多种合并症。本研究的目的是确定出院时使用药物的数量及其是否与1年后的临床结果相关。我们评估了京都充血性心力衰竭登记处（Kyoto充血性心力衰竭登记处）的2578例ADHF患者出院时的药物数量，并比较了按药物数量四分位数分类的四组1年预后（四分位数1，≤5；四分位数2,6-8；四分位数3,9-11；四分位数4，≥12）。出院时用药中位数为8种（四分位数区间6 ~ 11），服药5种以上的占81.5%，服药10种以上的占27.8%。1年累计死亡或再住院复合发生率（主要结局指标）随着用药数量的增加而逐渐增加（四分位数1,30.8%；四分位数2,31.6%；四分位数3,39.7%；四分位数4,50.3%;P < 0.0001）。调整混杂因素后，四分位数4相对于四分位数1的超额风险仍然显著（P = 0.01）。在日本ADHF患者的当代队列中，出院时多次用药是常见的，过度多次用药与1年内较高的死亡率和再住院风险相关。协作疾病管理项目包括对药物清单的仔细审查和适当的处方协议，应该对这些患者实施。
Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities. The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year. We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6–8; quartile 3, 9–11; and quartile 4, ≥ 12). At hospital discharge, the median number of medications was 8 (interquartile range, 6–11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01). In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients.