Cardiovascular polypharmacy is not associated with unplanned hospitalisation: evidence from a retrospective cohort study

Appleton, S. C.; Abel, Gary; Payne, Rupert

doi:10.1186/1471-2296-15-58

Cited by 29 publications

(30 citation statements)

References 11 publications

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“…It is not surprising that polypharmacy was linked to cardiovascular diseases. Polypharmacy in cardiovascular diseases is guided by evidence based guidelines recommending treatment with multiple drug classes [ 9 ]. For example, in heart failure the progressive use of multiple drugs and a complex therapeutic regimen are common and are driven by international guidelines.…”

Section: Discussionmentioning

confidence: 99%

Diseases Linked to Polypharmacy in Elderly Patients

Vrettos

Voukelatou

Katsoras

et al. 2017

Current Gerontology and Geriatrics Research

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Introduction Polypharmacy in several cases is deemed necessary and elderly patients are prone to this phenomenon. The objective of this study was to identify the prevalence and the predictors of polypharmacy among consecutively unplanned admissions of patients aged ≥65 years. Patients and Methods In 310 patients (51% women), mean age 80.24 years (95% CI 79.35–81.10), demographic characteristics, medical history, medications, and cause of admission were recorded. Parametric tests and multiple logistic regression analysis were applied to identify the factors that have significant association with polypharmacy. Results 53.5% of patients belonged to polypharmacy group. In multivariate analysis the independent predictors of polypharmacy were arterial hypertension (p = 0.003, OR = 2.708, and 95% CI 1.400–5.238), coronary artery disease (p = 0.001, OR = 8.274, and 95% CI 3.161–21.656), heart failure (p = 0.030, OR = 4.042, and 95% CI 1.145–14.270), atrial fibrillation (p = 0.031, OR = 2.477, and 95% CI 1.086–5.648), diabetes mellitus (p = 0.010, OR = 2.390, and 95% CI 1.232–4.636), dementia (p = 0.001, OR = 4.637, and 95% CI 1.876–11.464), and COPD (p = 0.022, OR = 3.626, and 95% CI 1.208–10.891). Conclusions Polypharmacy mainly was linked to cardiovascular diseases. If deprescribing is not feasible, physicians must oversee those patients in order to recognise early, possible drug reactions.

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Section: Discussionmentioning

confidence: 99%

Diseases Linked to Polypharmacy in Elderly Patients

Vrettos

Voukelatou

Katsoras

et al. 2017

Current Gerontology and Geriatrics Research

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“…Recent cohort studies using population datasets have challenged existing assumptions that polypharmacy is always hazardous, or indicative of poor care, and have highlighted the importance of considering the clinical context underlying prescribing [ 23 , 24 ]. For example, an analysis of Scottish primary care data linked to hospitalisations for a sample of approximately 180,000 adults showed that the strength of the association between the number of regular medicines and unplanned hospitalisations was greatly reduced when the number of clinical conditions was accounted for [ 23 ].…”

Section: Polypharmacy: ‘Many’ Medicines or ‘Too Many’ Medicines?mentioning

confidence: 99%

Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

2015

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The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between the prescribing of ‘many’ drugs and ‘too many’ drugs is a significant challenge. Clinicians are tasked with ensuring that patients receive the most appropriate combinations of medications based on the best available evidence, and that medication use is optimised according to patients’ clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because of the associated medication safety risks, such as drug interactions and adverse drug events. More recently, polypharmacy has been identified as a risk factor for under-prescribing, such that patients do not receive necessary medications and this can also pose risks to patients’ safety and well-being. The negative connotations that have long been associated with the term polypharmacy could potentially be acting as a driving factor for under-prescribing, whereby clinicians are reluctant to prescribe necessary medicines for patients who are already receiving ‘many’ medicines. It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration. In this article, we outline the current perspectives on polypharmacy and make the case for adopting the term ‘appropriate polypharmacy’ in differentiating between the prescribing of ‘many’ drugs and ‘too many’ drugs. We also outline the inherent challenges in doing so and provide recommendations for future clinical practice and research.

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“…Appropriate polypharmacy describes the necessary use of multiple evidence-based medications to improve the quality of a person's life and extend their life 4. We have previously demonstrated that the adverse consequences of polypharmacy are dependent on clinical context and have cautioned against assumptions that polypharmacy is always harmful and represents poor care 13 14. There is also clear evidence, albeit not in the older, multimorbid population, for the benefits of some multiple medications, for example, in the context of cardiovascular risk reduction 15…”

Section: Harms Of Polypharmacymentioning

confidence: 99%

Deprescribing: a primary care perspective

2016

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Polypharmacy is an increasing and global issue affecting primary care. Although sometimes appropriate, polypharmacy can also be problematic, leading to a range of adverse consequences. Deprescribing is the process of supervised withdrawal of an inappropriate medication and has the potential to reduce some of the problems associated with polypharmacy. It is a complex and sensitive process. We examine the issue of deprescribing from the perspective of primary care. Key steps in the deprescribing process are a review of medications and corresponding indications, consideration of harms, assessment of eligibility for discontinuation, prioritisation of medications and implementation of a stopping plan with appropriate monitoring. Patient involvement is a key feature of this process. Deprescribing should be considered in the context of end-of-life care and medication safety, but approaches are also required to identify other situations where deprescribing is appropriate. General practitioners are well positioned to facilitate deprescribing, usually through formal medication review, with decisions informed by a range of other healthcare professionals. Guidelines are available that help guide these processes. A range of studies have explored attitudes towards deprescribing; patients are generally supportive of the concept, although clinician views are varied. The successful implementation of deprescribing strategies still requires important patient and clinician barriers to be overcome, and clinical trial evidence of effectiveness and safety is essential.

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Cardiovascular polypharmacy is not associated with unplanned hospitalisation: evidence from a retrospective cohort study

Cited by 29 publications

References 11 publications

Diseases Linked to Polypharmacy in Elderly Patients

Diseases Linked to Polypharmacy in Elderly Patients

Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

Deprescribing: a primary care perspective

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