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Gardner K, Schwarz K, Pearson S, Jacknin G. Potentially Inappropriate Medication Usage in Older Adults in a Tertiary Academic Medical Center Emergency Department. J Pharm Pract 2021; 35:892-897. [PMID: 34000882 DOI: 10.1177/08971900211016813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Beers Criteria® medications are potentially inappropriate medications (PIMs) recommended by the American Geriatric Society to be avoided or used with caution in adults 65 years and older. The usage of PIMs in the emergency department (ED) setting is not well characterized. OBJECTIVES The purpose of this study is to evaluate the usage of PIMS in the ED. METHODS This is a single center retrospective observational study of a random sample of patients aged 65 and older who presented to the ED during a 6-month timeframe. The primary outcome was the incidence of ED readmissions in patients administered or prescribed a PIM compared with patients who were not prescribed or administered a PIM. Secondary outcomes included ED length of stay (LOS) and hospital admission. RESULTS Out of 192 patients, there was a total of 58 patients (30.2%) in the PIM group and 134 patients (69.8%) in the No PIM group. ED re-presentation within 30 days occurred in 10 patients (17%) in the PIM group vs 26 patients (19%) in the No PIM group (p = 0.88). The median ED LOS was 227 minutes vs 208 minutes (p = 0.1679). Hospital admission within 30 days occurred in 4 patients (7%) in the PIM group and 13 patients (10%) in the No PIM group (p = 0.725). CONCLUSIONS This analysis did not show statistically significant differences between patients who received a PIM compared to those who received an alternative medication with regard to re-presentation, admission, and ED LOS. ED LOS trended towards being longer in the PIM group.
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Affiliation(s)
- Katelyn Gardner
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Kerry Schwarz
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,UCHealth University of Colorado Hospital, Aurora, CO, USA
| | - Scott Pearson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,UCHealth University of Colorado Hospital, Aurora, CO, USA
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Drenth‐van Maanen AC, Wilting I, Jansen PAF. Prescribing medicines to older people-How to consider the impact of ageing on human organ and body functions. Br J Clin Pharmacol 2020; 86:1921-1930. [PMID: 31425638 PMCID: PMC7495267 DOI: 10.1111/bcp.14094] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 12/25/2022] Open
Abstract
Ageing is associated with several changes in human organs, which result in altered medication pharmacokinetics and pharmacodynamics. Ageing is also associated with changes in human body functions, such as impaired vision, hearing, swallowing, motor and cognitive functions, which can affect the adequate intake and administration of drugs. As a consequence, older people, and especially patients older than 75 years, are the main users of many drugs and they frequently use 5 drugs or more long-term (i.e. polypharmacy). All this increases the complexity of adequate drug intake, administration and adherence. However, there is a lack of evidence on the considerations that should be taken into account to ensure appropriate drug prescribing to older people. This review article summarizes the most clinically relevant changes in human organ and body functions and the consequential changes in pharmacokinetics and pharmacodynamics in older people, along with possible dosing consequences or alternatives for drugs frequently prescribed to this patient population. Recommendations are given on how ageing could be considered in clinical drug development, drug authorization and appropriate prescribing.
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Affiliation(s)
- A. Clara Drenth‐van Maanen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
| | - Ingeborg Wilting
- Department of Clinical PharmacyUniversity Medical Center Utrecht, The Netherlands
| | - Paul A. F. Jansen
- Geriatric DepartmentUniversity Medical Center UtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor), The Netherlands
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Akita K, Kohno T, Kohsaka S, Shiraishi Y, Nagatomo Y, Izumi Y, Goda A, Mizuno A, Sawano M, Inohara T, Fukuda K, Yoshikawa T. Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival. Int J Cardiol 2017; 235:162-168. [PMID: 28259550 DOI: 10.1016/j.ijcard.2017.02.070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute heart failure (HF) is a frequently encountered cardiac condition. Its prevalence increases exponentially with age. In spite of this, elderly patients are underrepresented in clinical trials and the implementation of guideline-based medical therapy (GBMT) in them is not well established. We investigated the current use of GBMT and its effects on mortality and HF rehospitalization among elderly patients with acute HF with reduced ejection fraction (HFrEF) using data obtained from a contemporary multi-center registry. METHODS AND RESULTS We analyzed data from 1,441 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry (mean age 73.2 ± 13.6 years). Reduced ejection fraction (<45%) was noted in 803 patients (55.7%), of which 237 were aged ≥80 years (elderly group). The prescription rate of GBMT (use of renin-angiotensin system inhibitors and β-blockers at discharge) was significantly lower in the elderly than in the younger (aged < 80 years) group (46.8% vs. 66.9%, p<0.001). Although GBMT at discharge was associated with reductions in HF readmission or the composite endpoint of cardiac death and HF readmission (HR 0.49, 95% CI 0.30-0.80; and HR 0.53, 95% CI 0.32-0.89, respectively) in the younger group, this association was not observed in the elderly group (HR 1.41, 95% CI 0.68-2.92; and HR 1.54, 95% CI 0.76-3.13, respectively) CONCLUSIONS: GBMT implementation in elderly patients with HFrEF was found to be suboptimal. However, the underuse of GBMT did not appear to be responsible for poorer outcomes in elderly HFrEF patients. Further research is required to establish an ideal therapeutic approach for this population. CLINICAL TRIAL REGISTRATION URL: http://www.umin.ac.jp/icdr/index-j.html. Unique identifier: UMIN000001171.
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Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuyuki Shiraishi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuji Nagatomo
- Division of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Yuki Izumi
- Division of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan
| | - Mitsuaki Sawano
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Taku Inohara
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Rossello X, Yellon DM. A critical review on the translational journey of cardioprotective therapies! Int J Cardiol 2016; 220:176-84. [DOI: 10.1016/j.ijcard.2016.06.131] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/03/2016] [Accepted: 06/23/2016] [Indexed: 01/08/2023]
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Burris JF, Tortorici MA, Mandic M, Neely M, Reed MD. Dosage Adjustments Related to Young or Old Age and Organ Impairment. J Clin Pharmacol 2016; 56:1461-1473. [PMID: 27539787 DOI: 10.1002/jcph.816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/11/2022]
Abstract
Differences in physiology related to young or old age and/or organ system impairment alter the absorption, distribution, metabolism, and excretion of many medications and consequently their effectiveness and toxicity. This module discusses common alterations in medication use and dosage that are required in the pediatric age group, in the elderly, and in patients with renal or hepatic disease.
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Affiliation(s)
- James F Burris
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Maja Mandic
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Neely
- Children's Hospital of Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael D Reed
- Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA
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De Spiegeleer B, Wynendaele E, Bracke N, Veryser L, Taevernier L, Degroote A, Stalmans S. Regulatory development of geriatric medicines: To GIP or not to GIP? Ageing Res Rev 2016; 27:23-36. [PMID: 26899877 DOI: 10.1016/j.arr.2016.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 12/13/2022]
Abstract
Geriatric patients represent the main users of medicines, but are historically often minimally included in clinical trials, resulting in a gap in the knowledge of the benefit/risk balance of medicines in this heterogeneous population. As the worldwide population is aging, the need for safe and effective medicines for older patients is proportionally increasing. The aim of this review is to provide an overview of the current regulatory status of the development of geriatric medicines, the encountered challenges and the view of the involved stakeholders, coming to the conclusion whether it is necessary or not to implement a Geriatric Investigation Plan (GIP), by analogy with pediatrics.
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Affiliation(s)
- Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Nathalie Bracke
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Lieselotte Veryser
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Lien Taevernier
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Agnes Degroote
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
| | - Sofie Stalmans
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Postal address: Ottergemsesteenweg 460 (second floor), B-9000 Ghent, Belgium.
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Rossello X, Pocock SJ, Julian DG. Long-Term Use of Cardiovascular Drugs: Challenges for Research and for Patient Care. J Am Coll Cardiol 2015; 66:1273-1285. [PMID: 26361160 DOI: 10.1016/j.jacc.2015.07.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/07/2015] [Indexed: 01/21/2023]
Abstract
Little is known about the benefits and risks of the long-term use of cardiovascular drugs. Evidence from randomized clinical trials (RCTs) rarely goes beyond a few years of follow-up, but patients are often given continuous treatment with multiple drugs well into old age. We focus on 4 commonly used cardiovascular drug classes: aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors given to patients after myocardial infarction. However, the issues raised apply more broadly to all long-term medications across cardiovascular diseases and the whole of medicine. The evidence and limitations of RCTs are addressed, as well as current practice in pre-licensing trials, the increasing problems of polypharmacy (especially in the elderly), the lack of trial evidence for withdrawal of drugs, the role of regulatory authorities and other stakeholders in this challenging situation, and the potential educational solutions for the medical profession. We conclude with a set of recommendations on how to improve the situation of long-term drug use.
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Affiliation(s)
- Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Stuart J Pocock
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom
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