Prevalence of heart failure pharmacotherapy utilisation, frailty and adverse drug events among hospitalised adults older than 75 years: a multicentre cross-sectional study

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2024-12-19 DOI:10.1111/imj.16612

Mai H. Duong, Danijela Gnjidic, Andrew J. McLachlan, Kevin Winardi, Alexandra A. Bennett, Fiona Blyth, David Le Couteur, Sarah N. Hilmer

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Abstract

Background

Optimal heart failure (HF) pharmacotherapy (guideline-directed medical therapy and diuretics) in older people with frailty is uncertain due to limited evidence.

Aims

To evaluate utilisation of HF pharmacotherapy and prevalence of polypharmacy, adverse drug events (ADEs), falls, delirium, renal impairment and duration of hospitalisation in older inpatients, according to frailty.

Methods

A retrospective cross-sectional study of the TO HOME cohort of 2000 inpatients ≥75 years admitted for ≥48 h to rehabilitation, geriatric or general medicine from 1 July 2016 to 30 June 2017 across six hospitals in Sydney, Australia. Data were collected from electronic medical records. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification identified HF diagnosis, ADEs and frailty using hospital frailty risk score. Outcomes included utilisation of HF pharmacotherapy; polypharmacy; ADEs, falls, delirium, renal and impairment; and duration of hospitalisation.

Results

Among 439 (22.0% of TO HOME cohort) patients with undifferentiated HF, 284 (69.5%) had intermediate or high risk of frailty, and 412 (94%) took ≥1 HF pharmacotherapy, with 357 (81.3%) patients on loop diuretics. Patients with high frailty risk frequently continued beta-blockers (70%) and discontinued renin-angiotensin system inhibitors (57%). Most patients experienced polypharmacy (n = 426, 97.0%). Renal impairment prevalence was 67%–76% across frailty groups. Increasing frailty risk (low, intermediate and high) was associated with increasing prevalence of ADEs (31%, 56% and 84%), falls (12%, 25% and 46%) and delirium (8%, 27% and 49%) and longer hospitalisation.

Conclusions

Frailty, HF-pharmacotherapy changes in hospital and ADEs were common among older inpatients with HF. The association of adverse outcomes according to frailty needs further investigation. Poor documentation of HF phenotype may be a barrier to medication optimisation in older inpatients.

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75岁以上住院成人心衰药物治疗使用率、虚弱和药物不良事件的患病率：一项多中心横断面研究

背景：由于证据有限，老年虚弱患者的最佳心力衰竭（HF）药物治疗（指南指导的药物治疗和利尿剂）尚不确定。目的：评估HF药物治疗的使用情况，以及老年住院患者多药、药物不良事件（ADEs）、跌倒、谵妄、肾功能损害和住院时间的患病率。方法：对2016年7月1日至2017年6月30日在澳大利亚悉尼6家医院接受康复、老年或普通医学治疗≥48小时的2000名≥75岁的住院患者进行回顾性横断面研究。数据是从电子病历中收集的。《国际疾病和相关健康问题统计分类》第十版澳大利亚修订版使用医院衰弱风险评分确定HF诊断、ADEs和衰弱。结果包括HF药物治疗的使用；复方用药;不良反应、跌倒、谵妄、肾功能损害；以及住院时间。结果：在439例（22.0%的TO HOME队列）未分化型心衰患者中，284例（69.5%）有中高脆弱风险，412例（94%）接受了≥1型心衰药物治疗，357例（81.3%）患者接受了循环利尿剂治疗。有高衰弱风险的患者经常继续使用-受体阻滞剂（70%）和停用肾素-血管紧张素系统抑制剂（57%）。大多数患者有多种用药（n = 426, 97.0%）。在虚弱组中，肾脏损害患病率为67%-76%。增加的衰弱风险（低、中、高）与ade（31%、56%和84%）、跌倒（12%、25%和46%）和谵妄（8%、27%和49%）的患病率增加以及住院时间延长相关。结论：衰弱、院内HF药物治疗改变和ADEs在老年HF住院患者中普遍存在。与虚弱相关的不良后果需要进一步调查。心衰表型的不良记录可能是老年住院患者药物优化的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.