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Buttard M, Putot A, d'Athis P, Pioro L, Asgassou S, Putot S, Deïdda M, Laborde C, Dipanda M, Mahmoudi R, Manckoundia P. [Evaluation of the prescription of furosemide in persons aged 75years and older in a geriatric acute-care unit]. Ann Cardiol Angeiol (Paris) 2018; 67:238-243. [PMID: 29759801 DOI: 10.1016/j.ancard.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Furosemide is very often prescribed in France. It may cause important adverse effects especially in elderly persons. In order to limit its misuse and excessive expenditure for health insurance organizations, the European Society of Cardiology drafted strict guidelines for its prescription. We conducted a study in this population to determine the rate of prescription of furosemide in elderly persons outside the guidelines. METHOD This was a prospective, single-centre, observational study bearing on elderly persons aged 75years and more admitted to a geriatric acute-care unit over a period of 6months. The prevalence of furosemide prescription and the proportion of prescriptions outside guidelines were calculated. The sociodemographic and medical characteristics of patients treated with furosemide were studied as were the modalities of furosemide prescription. RESULTS In the 818 patients hospitalized during the period of the study, 267 were taking furosemide at admission (32.6%). Among these prescriptions, 69.2% were outside the guidelines. Arterial hypertension was the leading indication for furosemide (38.2%), followed by chronic heart failure (24.3%). CONCLUSION This study confirmed the high prevalence of furosemide prescription and its misuse. Furosemide is often re-prescribed with no medical re-evaluation.
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Affiliation(s)
- M Buttard
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - A Putot
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - P d'Athis
- Département d'information médicale, hôpital François-Mitterrand, CHU, BP 87 909, 2, rue Maréchal-de-Lattre-de-Tassigny, 21079 Dijon cedex, France
| | - L Pioro
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - S Asgassou
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - S Putot
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - M Deïdda
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - C Laborde
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - M Dipanda
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France
| | - R Mahmoudi
- Service de médecine interne et gériatrie, hôpital Maison-Blanche, CHU, 51092 Reims, France
| | - P Manckoundia
- Pôle personnes âgées, hôpital de Champmaillot, CHU, BP 87 909, 2, rue Jules-Violle, 21079 Dijon cedex, France; UMR Inserm/U1093 cognition, action, plasticité sensorimotrice, université de Bourgogne Franche-Comté, 21078 Dijon cedex, France.
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Rodriguez-Cillero C, Menu D, d'Athis P, Perrin S, Dipanda M, Asgassou S, Guepet H, Mazen E, Manckoundia P, Putot A. Potentially inappropriate use of furosemide in a very elderly population: An observational study. Int J Clin Pract 2017; 71. [PMID: 28618134 DOI: 10.1111/ijcp.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/14/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients. METHODS All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included. RESULTS Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide. CONCLUSIONS In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.
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Affiliation(s)
| | - Didier Menu
- "Mutualité Sociale Agricole de Bourgogne", Dijon, France
| | - Philippe d'Athis
- Department of Biostatistics and Medical Computing, University Hospital, Dijon, France
| | - Sophie Perrin
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Mélanie Dipanda
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Sanaa Asgassou
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Hélène Guepet
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Emmanuel Mazen
- Department of Geriatric Medicine, University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Medicine, University Hospital, Dijon, France
- UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy Franche Comté, Dijon, France
| | - Alain Putot
- Department of Geriatric Medicine, University Hospital, Dijon, France
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van Blijderveen JC, Straus SM, de Ridder MA, Stricker BH, Sturkenboom MC, Verhamme KM. Adherence to renal function monitoring guidelines in patients starting antihypertensive therapy with diuretics and RAAS inhibitors: a retrospective cohort study. Drug Saf 2014; 37:369-77. [PMID: 24748427 DOI: 10.1007/s40264-014-0160-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) might complicate antihypertensive therapy. In The Netherlands, general practitioner clinical practice guidelines provide clear recommendations on monitoring of renal function to minimize this risk. Our objective was to investigate how day-to-day clinical practice corresponds to the guidelines. METHODS We conducted a retrospective cohort study in a dynamic population, using data on >9,000 adults that was retrieved from the Integrated Primary Care Information database. We investigated whether serum creatinine (SCR) was measured within 30 and 365 days after the start of (combined) use of a diuretic, an angiotensin-converting enzyme inhibitor, and/or angiotensin receptor blocker. We also investigated the association between calendar year, sex, type of therapy, risk factors for AKI and practice and SCR measurement. RESULTS Of 6,593 subjects who met the study criteria for single drug therapy, SCR was measured in 1,233 subjects within 30 days and in 3,896 subjects within 365 days. For combined drug therapy recipients (n = 2,497), these were 545 and 1,687, respectively. Associated cumulative probabilities were 19 % and 66 % with single drug therapy, and 22 % and 74 % with combined drug therapy. Significant differences were observed between practices. SCR measurement was associated with other characteristics, except for sex. Within 365 days, SCR increased >30 % of baseline in 103 subjects (1.6 %) after the start of single drug therapy, and in 85 (3.4 %) subjects who initiated combined drug therapy. In the majority (>70 %) of these subjects, this did not result in subsequent monitoring or adjustment of antihypertensive treatment. CONCLUSIONS Results from this study suggest that, on average, renal function is not monitored as strictly as recommended by relevant clinical practice guidelines.
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Affiliation(s)
- Jan C van Blijderveen
- Department of Medical Informatics, Erasmus Medical Center, Room Ee2116, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands,
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McDowell SE, Ferner RE. Biochemical monitoring of patients treated with antihypertensive therapy for adverse drug reactions: a systematic review. Drug Saf 2012; 34:1049-59. [PMID: 21981433 DOI: 10.2165/11593980-000000000-00000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Biochemical monitoring of patients treated with antihypertensive therapy is recommended in order to identify potential adverse reactions to treatment. We aimed to review the literature investigating the nature of biochemical monitoring in adults treated in primary care with antihypertensive drugs. Specifically, we wished to establish (i) the proportion of patients with biochemical baseline testing prior to the initiation of antihypertensive therapy; (ii) the proportion of patients with biochemical monitoring after initiation of antihypertensive therapy; (iii) the patient characteristics associated with biochemical monitoring; (iv) the frequency of biochemical monitoring after the initiation of antihypertensive therapy; and (v) the relationship, if any, between biochemical monitoring and adverse patient outcomes. We searched MEDLINE, EMBASE and Google Scholar from 1948 to 31 December 2010 using a combination of text words and search terms. Retrospective and prospective cohort studies, cross-sectional studies, randomized controlled trials or quasi-randomized controlled trials, and audits of current clinical practice were included. Clinical trials, case reports and case series were excluded. Studies were included if they provided data on the proportion of patients treated with antihypertensive therapy in primary care who had any biochemical monitoring before or after the initiation of therapy. In total, 15 studies were included in our review, which used a wide variety of definitions of monitoring prior to and after the initiation of antihypertensive therapy. From 17% to 81% of patients treated with antihypertensive drugs had a baseline biochemical test and from 20% to 79% had any follow-up monitoring. In only 7 of the 12 studies that examined follow-up monitoring did more than half of the patients have any monitoring. Overall, this systematic review provides evidence that monitoring as recommended by published guidelines is not commonly undertaken. Only two studies were identified that examined patients with both baseline testing and follow-up monitoring. Omission of one or the other limits the ability to analyse the effect of treatment on electrolyte concentrations or renal function. There is limited research on the patient factors associated with monitoring and further work is required to determine the impact of monitoring on adverse patient outcomes. Important barriers to effective monitoring exist and this review emphasizes that these have not yet been overcome.
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Martin-Latry K, Cougnard A. Terminologie utilisée concernant les bases de remboursement de l’assurance maladie en pharmaco-épidémiologie : une harmonisation nécessaire. Therapie 2010; 65:379-85. [DOI: 10.2515/therapie/2010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
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Martin-Latry K, Bégaud B. Pharmacoepidemiological research using French reimbursement databases: yes we can! Pharmacoepidemiol Drug Saf 2010; 19:256-65. [PMID: 20128015 DOI: 10.1002/pds.1912] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe the reimbursement databases available in France for pharmacoepidemiological research and their use. METHODS France has a publicly funded health system that systematically covers the population. Within this system, three main insurance schemes provide health services to citizens in France and each have their own reimbursement database. Together these three databases cover almost 97% of the French population (respectively for 54.5, 3.6, and 3.3 million individuals, and a total of 61.4 million individuals). Data in these concern patients, prescribers, all the medical acts reimbursed, prescription and undertaking of laboratory tests (but without results), private hospital data, partial public hospital data and vital status. Their use is regulated but access is free and the data are anonymous. PubMed and Scopus were searched for relevant studies published from January 1988 to June 2009. RESULTS 110 published studies were included. The topics and the study characteristics were extremely wide-ranging. The studies assessed patterns of drug use, have tested interventions, supported or improved prescribing practices, tested compliance with the French governmental Health guidelines, assessed physicians' prescribing practices and performed economic and cost-effectiveness assessments. The number of articles published increased greatly between 2002 and 2003. CONCLUSIONS The French reimbursement databases were greatly used over the last 20 years. They can provide data on exposure to drugs and can be used to study patterns of drug utilization although their limitations must be considered.
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Affiliation(s)
- Karin Martin-Latry
- Département de Pharmacologie, Université Victor Segalen Bordeaux 2, 33076 Bordeaux, France.
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