156 Potentially Inappropriate Cardiovascular Medications in Czech Older Adults in Acute Care: Inomed and Euroageism H2020 Project

Introduction

Cardiovascular disorders (CVS) belong to the most frequent causes of deaths and cardiovascular medications among the most common drugs. Older patients are vulnerable to drug risks due to presence of pharmacological changes, polymorbidity, polypharmacy and geriatric syndromes. Thus, the effort to reduce prescribing of potentially inappropriate medications (PIMs) represents a substantial prevention strategy in this population.

Methods

This was a prospective, cross-sectional study conducted in 288 patients (65+) admitted to acute care geriatric wards in the Czech Republic from Aug 2018 to Jan 2019. We aimed to investigate prevalence of CVS PIMs using relevant parts of STOPP/START 2015 criteria, the EU(7) PIM 2015 list and the Beers criteria 2019. Only patients with stable health conditions were included in our study. Results: Overall prevalence of CVS PIMs was 77.6%. Undertreatment of CVS problems, identified by START criteria, was found in 63.2% patients. Prevalence of CVS PIMs according to different criteria was 16.1%, 23.6% and 30.9%, using the Beers criteria 2012, STOPP criteria and the EU (7)-PIM list; respectively. The most prevalent problem of undertreatment was the absence of statins with documented history of coronary, cerebral and peripheral vascular disease (excluding patients at the end-of-life or at the age of >85 years) (27.3%). According to the EU (7)-PIM list, the most common CVS PIMs were the use of amiodarone in maintenance doses of >200 mg/48 hours and use of spironolactone in doses of >25 mg/day (9.0% and 5.6%; respectively).

Conclusions

This study confirmed high prevalence of CVS PIMs in older adults admitted to acute care hospitals in the Czech Republic. Detecting and identifying CVS PIMs is of high importance in order to prevent serious adverse drug events, higher mortality and increased frailty in vulnerable older population. Grant support: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), H2020-MCSF-ITN-764632, PROGRESS Q42 FoP, Charles University, SVV 260417.

Pregnancy outcomes after a mass vaccination campaign with an oral cholera vaccine: a systematic review and meta-analysis

BACKGROUND

Cholera has harmful effects on the fetus but safety data on the oral cholera vaccine in pregnant women are controversial.

OBJECTIVES

We conducted the first meta-analysis of studies in pregnant women comparing the effect of oral cholera vaccination on pregnancy outcomes with unvaccinated women. Outcomes of interest were adverse pregnancy outcome, miscarriage, stillbirth, preterm delivery, low birthweight, abortion and malformation.

SEARCH STRATEGY

The search was run in MEDLINE/PubMed, SCOPUS and Embase databases from inception up to December 2019.

SELECTION CRITERIA

Inclusion criteria were: (1) studies that investigated the association between oral cholera vaccines and adverse pregnancy outcomes; (2) studies that reported outcomes with appropriate estimates; and (3) studies that contained an unvaccinated control group.

DATA COLLECTION AND ANALYSIS

A random-effects model (DerSimonian and Laird) was run to evaluate the overall treatment effect (relative risk, RR). The PRISMA statement was followed in reporting this meta-analysis.

MAIN RESULTS

Five studies included in meta-analysis with 5584 women (2920 exposed and 2664 not exposed). No significant increase in adverse pregnancy outcome (RR 1.03, 95% CI 0.79-1.34), miscarriage (RR 1.15, 95% CI 0.84-1.57) or stillbirth (RR 1.11, 95% CI 0.69-1.80) following cholera vaccine administration was found compared with control group. There was also no association with an increased risk of preterm delivery (RR 0.61, 95% CI 0.35-1.06) low birthweight (RR 0.84, 95% CI 0.56- 1.26), accidental abortion (RR 1.02, 95% CI 0.77-1.35) or malformation (RR 0.70, 95% CI 0.22-2.25).

CONCLUSIONS

This study shows no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.

TWEETABLE ABSTRACT

There is no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.

P5317Prevalence of cardiovascular diseases in the Middle-East: systemic review and meta-analysis

Background

Cardiovascular diseases are the leading cause of mortality in the world and CVDs are responsible for 34% of all deaths in the middle east population. To better understanding of the current CVD prevalence in the middle east population we conducted this systematic review and meta-analysis.

Aim

To assess the prevalence and risk factors of CVD among middle east adult population from the published literature.

Methods

Electronic data basis such as PubMed, Sciencedirect, Embase and Google scholar were searched, from the year 2011 to December 2018. All the original articles published in English and have investigated the prevalence of CVD and risk factors. Study characteristics, participants demographics and risk factors of CVD were recorded. To pull the CVD prevalence, we used random effect meta-analysis. we assess heterogeneity using both the formal tests and subgroup analysis. We also assessed the quality of the studies and examined the publication bias.

Results

We retrieved 2931 potentially relevant papers through searches of electronic and gray literatures, of which 44 articles met inclusion criteria after the screening and were included in systematic review and meta-analysis (N=191,979). The weighted pooled prevalence of CVD was 13.7% (95% CI: 11.1%-16.3%) in the Middle-East. The prevalence of cardiovascular disease risk factors such as dyslipidemia accounts 43.1% (95% CI: 17%-69.3%), diabetes mellitus 32.3%, 95% CI: 23.8%-40.8%), hypertension 30.7% (95% CI: 25.2%-36.3%). Other traditional CVD risk factors, smoking 16.3% (95% CI: 12.9%-19.7%), and family history of CVDs 18.7% (95% CI: 15.2%-22.2%).

Conclusion

A high CVD prevalence of 13.7% was identified and dyslipidemia remain to be a significant independent risk factor for CVD in the Middle-East. Interventional strategies are urgently required for primary prevention of CVD and its associated risk factors in Middle East population.