Comorbidity and low use of new antiplatelets in acute coronary syndrome

Aboal, Jaime; Llaó, Isaac; García, Cosme García; Sans‐Roselló, Jordi; Sambola, Antonia; Andrea, Rut; Tomás, Carlos; Bonet, Gil; Arizá-Solé, Albert; Viñas, David; Vilà, Teresa Oliveras; Montero, Santiago; Cantalapiedra, Javier; Pujol‐López, Margarida; Hernández, Isabel; Pérez-Rodríguez, María Teresa; Loma-Osorio, Pablo; Sánchez‐Salado, José Carlos

doi:10.1007/s40520-019-01348-7

Cited by 5 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multimorbidity, evaluated by the Charlson index [21], was not associated with PAI underuse in our series. Our findings are contrary to a previous study that found a low Charlson index to be an independent predictive factor for the use of PAI in the acute phase of myocardial infarction [36]. More generally, multimorbidity has been associated with underuse of indicated medications in hospitalized American veterans [37].…”

Section: Factors Associated With Pai Prescriptionscontrasting

confidence: 99%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

View full text Add to dashboard Cite

Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

show abstract

Section: Factors Associated With Pai Prescriptionscontrasting

confidence: 99%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

View full text Add to dashboard Cite

show abstract

“…CCI for each individual patient was computed using an online calculator [26]. For the purpose of this study, CCI was categorized as low (0-1), intermediate (2)(3), high (4-5) and very high (≥6) similar to other studies [27,28].…”

Section: Sample Size Calculation and Total Number Of Patientsmentioning

confidence: 99%

Adjustments of medication dosages in patients with renal impairment in Botswana; findings and implications to improve patient care

Sheikh¹,

Rwegerera

Godman

et al. 2019

Hospital Practice

View full text Add to dashboard Cite

Background and aims: Medication dosage adjustments for renally impaired patients have not been studied in Botswana. This study was conducted to determine prescribing practices among patients with renal impairment in medical wards to improve future patient care. Methods: We conducted a retrospective study involving medical charts of patients admitted at a tertiary level hospital in Gaborone Botswana. Study participants included all patients admitted between August and October 2016 who were hospitalized for ≥24 hours. "Drug prescribing in renal failure: dosing guidelines for adults and children." was used to determine extent of dosage adjustments. A logistic regression model was used to assess which patient factors were associated with inappropriate dosage adjustment. Results: Twenty nine percent (233/804) of patients had renal impairment. Of these, 184 patients with renal impairment were included in the final analysis. There were 1143 prescription entries, of which 20.5% (n=234) required dosage adjustment for renal function but only 45.7% (n=107) were adjusted correctly. Of note, 112 patients were prescribed at least one drug that required dosage adjustment and only 30.4% (n=34) patients had all of their medications appropriately adjusted. Patient factors associated with inappropriate dosage adjustment included a higher number of medicines being prescribed. Mortality among patients with renal impairment was independently associated with higher scores of Charlson comorbidity index and hospital stay duration of 1-7 days. Conclusion: The renal function status of patients was not sufficiently taken into account when prescribing medicines especially in patients with severely impaired kidney function in Botswana. Continuous medical education needs to be encouraged to address this, which is being implemented. We will be following this up in future studies.

show abstract

“…TIMI flow grade < 3 after PCI has been related to poor outcomes in patients with acute coronary syndromes [25] . In addition, as described in previous reports [26] age-related comorbidity and a higher bleeding risk could conditioned a lower use of new antiplatelet agents in the elderly group. This fact along with that age by itself can lead to an impaired coronary microcirculation state [27] , could explain this higher rate of TIMI flow grade < 3 after PCI, and in turn, could also influence the outcomes.…”

Section: Discussionmentioning

confidence: 65%

“Impact of age on management and prognosis of resuscitated sudden cardiac death patients”

Roselló

Vidal-Burdeus

Loma-Osorio

et al. 2022

IJC Heart & Vasculature

Self Cite

View full text Add to dashboard Cite

Comorbidity and low use of new antiplatelets in acute coronary syndrome

Cited by 5 publications

References 26 publications

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Adjustments of medication dosages in patients with renal impairment in Botswana; findings and implications to improve patient care

“Impact of age on management and prognosis of resuscitated sudden cardiac death patients”

Contact Info

Product

Resources

About