Academic Medical Organization of Southwestern Ontario.

Academic Medical Organization of Southwestern Ontario.

Study queStionDo men starting treatment with prostate-specific α antagonists have increased risk of fall and fracture? MethodSAdministrative datasets from the province of Ontario, Canada, that contain patient level data were used to generate a cohort of 147 084 men aged ≥66 years who filled their first outpatient prescription for prostatespecific α antagonists tamsulosin, alfuzosin, or silodosin between June 2003 and December 2013 (exposed men) plus an equal sized cohort matched 1:1 (using a propensity score model) who did not initiate α antagonist therapy. The primary outcome was a hospital emergency room visit or inpatient admission for a fall or fracture in the 90 days after exposure. Study anSwer and liMitationSThe men exposed to prostate-specific α antagonist had significantly increased risks of falling (odds ratio 1.14 (95% CI 1.07 to 1.21), absolute risk increase 0.17% (0.08 to 0.25%)) and of sustaining a fracture (odds ratio 1.16 (1.04 to 1.29), absolute risk increase 0.06% (0.02 to 0.11%)) compared with the unexposed cohort. This increased risk was not observed in the period before α antagonist use. Secondary outcomes of hypotension and head trauma were also significantly increased in the exposed cohort (odds ratios 1.80 (1.59 to 2.03) and 1.15 (1.04 to 1.27) respectively). The two cohorts were similar across 98 different covariates including demographics, comorbid conditions, medication use, healthcare use, and prior medical investigation. Potential unmeasured confounders, such as physical deconditioning, mobility impairment, and situational risk factors, may exist. The data used to identify the primary outcomes had limited sensitivity, so the absolute risks of the outcomes are probably underestimates. The study only included men ≥66 years old, and 84% of exposed men were prescribed tamsulosin, so results may not be generalizable to younger men, and there may not be statistical power to show small differences in outcomes between the drugs.what thiS Study addS Prostate-specific α antagonists are associated with a small but significant increased risk of fall, fracture, and head trauma, probably as a result of induced hypotension. Funding, CoMpeting intereStS, data SharingThis project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site through the Kidney, Dialysis, and Transplantation (KDT) research program. BW has received a research grant from Astellas, and L-AF does consultancy for Amgen. IntroductionAs men age, many will develop bothersome lower urinary tract symptoms such as urinary frequency, urgency, nocturia, and a weak urinary stream. These symptoms are often attributed to benign prostatic hyperplasia and are treated because of their negative impact on quality of life. 1 The introduction of several α antagonist medications in the 1990s fundamentally changed the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. 2 3 These medications relax the prostatic smooth muscle and improve urinary flow rates and symptoms. 1 2 Non-specific (fi...

pared with never users. Cumulative use was not associated with increased odds of acute pancreatitis (P for trend among users = .49). Use of other antiarrhythmic drugs was not associated with acute pancreatitis (Table 2). Discussion | In this study of health care utilization data, use of amiodarone but not of other antiarrhythmic drugs was associated with a 50% increased odds of acute pancreatitis among patients with NVAF. The odds were almost doubled in the 12 months after amiodarone therapy initiation and did not depend on cumulative use of amiodarone. Considering an incidence of acute pancreatitis of 3 to 4 cases per 10 000 adults per year, 4 the observed association would result in approximately 1 to 2 additional cases of acute pancreatitis per 10 000 amiodarone users per year. A few isolated case reports of acute pancreatitis possibly linked to amiodarone use have been described in the literature. 1-3 The mechanisms responsible for this association are unknown, although direct cytotoxicity or immune-mediated pathways, as described for amiodarone-related pulmonary toxic effects, could be potential explanations. 5 Strengths of our study include the prospective assessment of medication use, the large sample size, and the availability of information on comorbidities and use of other medications potentially associated with increased risk of acute pancreatitis. Limitations are related to the use of health care utilization data: limited information on the validity of claims for acute pancreatitis, absence of clinical variables that characterize severity of the episode (eg, blood markers of acute pancreatitis), and the select group of patients included in this database. Our results indicate that acute pancreatitis could be an adverse effect of amiodarone use, an effect that may not be shared by other antiarrhythmic drugs. Even though the absolute risk of acute pancreatitis in the general population is low, health care professionals should be aware of this potential association in the treatment of patients with NVAF or acute pancreatitis. Further research should replicate our findings and determine potential mechanisms.

Objective:To determine the risk of hospitalization and death associated with pimavanserin use.Methods:We conducted a retrospective cohort study of adults 65 years and older with Parkinson’s disease between November 1, 2015 and December 31, 2018 using an administrative dataset on residents of Medicare-certified long-term care facilities and linked Medicare claims data. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance pimavanserin users and nonusers on 24 baseline characteristics. Fine-Gray competing risk and Cox proportional hazards regression models were used to estimate the risk of hospitalization and death up to one year, respectively.Results:The study cohort included 2,186 pimavanserin users and 18,212 nonusers. There was a higher risk of 30-day hospitalization with pimavanserin use vs. nonuse (IPTW adjusted hazard ratio [aHR] 1.24, 95% confidence intervals [CI] 1.06–1.43). There was no association of pimavanserin use with 90-day hospitalization (aHR 1.10, CI 0.99–1.24) nor with 30-day mortality (aHR 0.76, CI 0.56–1.03). Pimavanserin use vs. nonuse was associated with an increased 90-day mortality (aHR 1.20, CI 1.02–1.41) that persisted after 180 days (aHR 1.28, CI 1.13–1.45) and 1 year (aHR 1.56, CI 1.42–1.72).Conclusions:Pimavanserin use vs. nonuse in older adults was associated with an increased risk of hospitalization at one month of initiation and a higher risk of death for up to one year following initiation. These findings, in a large real-world cohort within long-term care facilities, may help to inform decisions regarding its risk-benefit balance among patients with Parkinson’s disease.Classification of Evidence:This study provides Class II evidence that in patients with Parkinson’s disease who are 65 or older and residing in Medicare-certified long-term care facilities, pimavanserin prescribing is associated with an increased risk of 30-day hospitalization and higher 90-, 180-, and, 365-day mortality.

Introduction: Length-of-stay (LOS), 30-day readmission, and 30-day mortality are metrics used to assess quality of care and provider reimbursement. Therefore, we investigated patient-and hospital-level characteristics associated with the three healthcare quality metrics for radical nephrectomy with inferior vena cava (IVC) thrombectomy. Methods: Using the National Cancer Data Base, we established a cohort of patients who received radical nephrectomy following the diagnosis of renal cell carcinoma (RCC) stage cT3b between 1998 and 2011. We then assessed the associations between patient-or hospital-level characteristics and LOS using multivariable negative binomial regression. We used multivariable logistic regression to determine the associations between the characteristics and 30-day readmission or 30-day mortality. Results: During the study period, 5768 patients were diagnosed with RCC stage cT3b and underwent radical nephrectomy. LOS ≤2 days and ≥9 days were associated with a higher likelihood of 30-day readmission (respective odds ratio [OR] 1.61 and 1.58) and 30-day mortality (respective OR 11.62 and 11.87). Older patients (60-79 years vs. <50 years) were less likely to experience 30-day readmission (OR 0.46-0.52). Older patients (≥80 years vs. <50 years, OR 3.67) and patients with a high index of comorbidity (Charlson comorbidity score ≥ 2 vs. 0, OR 1.95) were more likely to suffer 30-day mortality. Conclusions: LOS is an important predictor of short-term readmission and mortality following radical nephrectomy with IVC thrombectomy. Older age and a high index of comorbidity also predict short-term mortality after the surgery.

Introduction The relationship between cannabis use and hypertension is not clear based on prior epidemiological studies. Thus, we examined this relationship over a 3‐year follow‐up period using a large population‐based sample from the USA. Methods Self‐reported longitudinal data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 1 (2001/2002) and Wave 2 (2004/2005). The sample was restricted to participants who did not report hypertension at baseline (n = 26 844; 51% 40 years and older, 51% female, 71% white). χ2‐tests were used to examine the distributions of confounders stratified by the incidence of hypertension. Thereafter, multiple logistic regression analyses were conducted to quantify the relationships between lifetime cannabis use, 12‐month cannabis use and 12‐month cannabis use frequency and incidence of hypertension while adjusting for confounders. Results Cannabis use was associated with a decreased incidence of hypertension in the unadjusted analyses. However, the relationships were confounded by age. After adjustment for all confounders, neither lifetime cannabis use (odds ratio, 95% confidence interval 0.89, 0.77 to 1.02), 12‐month cannabis use (0.78, 0.56 to 1.09) nor 12‐month cannabis use frequency [at least monthly use (0.85, 0.57 to 1.28) and less than monthly use (0.67, 0.40 to 1.11)] were associated above chance with the incidence of hypertension. Discussion and Conclusions Lifetime cannabis use, 12‐month cannabis use and 12‐month cannabis use frequency were not associated with the incidence of hypertension.

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