Risk factors for cardiovascular events of antidementia drugs in Alzheimer's disease patients

Inmaculada Hernandez PharmD
{"title":"Risk factors for cardiovascular events of antidementia drugs in Alzheimer's disease patients","authors":"Inmaculada Hernandez PharmD","doi":"10.1016/j.jcgg.2016.01.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Antidementia drugs have been associated with an increased risk of cardiovascular events. The objective of this study was to identify the predictors for cardiovascular events among patients with Alzheimer's disease (AD) on antidementia drugs, mining large longitudinal claims data.</p></div><div><h3>Methods</h3><p>Using 2006–2011 claims from a 5% random sample of Medicare beneficiaries, I identified patients with AD who filled a prescription for an antidementia drug between 2007 and 2011. I followed them from the initiation of the antidementia drug until a cardiovascular event or December 31, 2011, censored by death or discontinuation of antidementia drugs. The outcome was the incidence of cardiovascular events, which include acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT prolongation, and ventricular tachycardia. Covariates included predefined patient characteristics and empirical attributes identified from the claims, including <em>International Classification of Diseases, Ninth Revision</em> (ICD-9) diagnosis codes, Healthcare Common Procedure Coding System codes, and therapeutic classes of all prescriptions filled. After using feature selection to choose the top covariates, a logistic regression with multivariate variable selection was constructed.</p></div><div><h3>Results</h3><p>With an accuracy of 83.9% and a sensitivity of 93.3%, the algorithm identified 22 predictors for cardiovascular events, including a history of ischemic heart disease, congestive heart failure, syncope, stroke or transient ischemic attack, diabetes, number of other comorbidities, and procedures including venipuncture and radiologic examinations.</p></div><div><h3>Conclusion</h3><p>The results of this study can help clinicians identify AD patients with a higher risk of cardiovascular events who therefore should be prescribed antidementia drugs cautiously.</p></div>","PeriodicalId":100764,"journal":{"name":"Journal of Clinical Gerontology and Geriatrics","volume":"7 3","pages":"Pages 77-82"},"PeriodicalIF":0.0000,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jcgg.2016.01.002","citationCount":"7","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Gerontology and Geriatrics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S221083351600006X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 7

Abstract

Background

Antidementia drugs have been associated with an increased risk of cardiovascular events. The objective of this study was to identify the predictors for cardiovascular events among patients with Alzheimer's disease (AD) on antidementia drugs, mining large longitudinal claims data.

Methods

Using 2006–2011 claims from a 5% random sample of Medicare beneficiaries, I identified patients with AD who filled a prescription for an antidementia drug between 2007 and 2011. I followed them from the initiation of the antidementia drug until a cardiovascular event or December 31, 2011, censored by death or discontinuation of antidementia drugs. The outcome was the incidence of cardiovascular events, which include acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT prolongation, and ventricular tachycardia. Covariates included predefined patient characteristics and empirical attributes identified from the claims, including International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, Healthcare Common Procedure Coding System codes, and therapeutic classes of all prescriptions filled. After using feature selection to choose the top covariates, a logistic regression with multivariate variable selection was constructed.

Results

With an accuracy of 83.9% and a sensitivity of 93.3%, the algorithm identified 22 predictors for cardiovascular events, including a history of ischemic heart disease, congestive heart failure, syncope, stroke or transient ischemic attack, diabetes, number of other comorbidities, and procedures including venipuncture and radiologic examinations.

Conclusion

The results of this study can help clinicians identify AD patients with a higher risk of cardiovascular events who therefore should be prescribed antidementia drugs cautiously.

阿尔茨海默病患者服用抗痴呆药物导致心血管事件的危险因素
背景抗痴呆药物与心血管事件的风险增加有关。本研究的目的是通过挖掘大量纵向索赔数据,确定阿尔茨海默病(AD)患者服用抗痴呆药物后心血管事件的预测因素。方法利用2006年至2011年来自5%的医疗保险受益人的随机样本的索赔,我确定了在2007年至2011年间开具抗痴呆药物处方的AD患者。我从开始服用抗痴呆药物一直跟踪他们,直到发生心血管事件或2011年12月31日,因死亡或停用抗痴呆药物而受到审查。结果是心血管事件的发生率,包括急性心肌梗死、心动过缓、晕厥、房室传导阻滞、QT延长和室性心动过速。协变量包括预定义的患者特征和从索赔中确定的经验属性,包括国际疾病分类、第九次修订版(ICD-9)诊断代码、医疗保健通用程序编码系统代码和所有处方的治疗类别。在使用特征选择来选择顶部协变量之后,构建了具有多变量选择的逻辑回归。结果该算法的准确率为83.9%,灵敏度为93.3%,确定了22个心血管事件的预测因素,包括缺血性心脏病、充血性心力衰竭、晕厥、中风或短暂性脑缺血发作、糖尿病、其他合并症的数量,以及静脉穿刺和放射学检查等程序。结论这项研究的结果可以帮助临床医生识别心血管事件风险较高的AD患者,因此应该谨慎地给他们开抗痴呆药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信