Polypharmacy Management in a Gender Perspective: At the Heart of the Problem: Analysis of Major Cardiac Diseases, SARS-CoV-2 Affection and Gender Distribution in a Cohort of Patients in Internal Medicine Ward

Pietrantonio, Filomena; Ciamei, Angela; Vinci, Antonio; Ciarambino, Tiziana; Alessi, Elena; Pascucci, Matteo; Castelli, Michela Delli; Zito, Silvia; Sanguedolce, Simona; Rainone, Marianna; Lorenzo, Jacopo Di; Vinci, Fabio; Laurelli, Giulia; Iorio, Carlo; Corsi, Roberto; Ricci, Serafino; Berardino, A. Di; Ruggeri, Matteo; Rosiello, Francesco

doi:10.3390/ijerph20095711

Cited by 3 publications

(1 citation statement)

References 46 publications

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“…It is staffed by 3312 employees (including administration and healthcare providers). It includes 4 hospital structures, 8 medium-intensity private structures, and at least 36 low-intensity territorial facilities for vulnerable patients [ 20 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

Pietrantonio,

Vinci,

Maurici

et al. 2023

Sensors

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Background: In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. Methods: To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient’s perspective). In this perspective paper, the main findings of these studies, from the operators’ point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. Results: Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. Conclusions: The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.

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Section: Methodsmentioning

confidence: 99%

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

Pietrantonio,

Vinci,

Maurici

et al. 2023

Sensors

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Prevention is better than healing. Clinical and economic implications of oral antiviral agents in COVID-19: a prospective study

Pietrantonio,

Rosiello,

Ruggeri

et al. 2024

Ital J Med

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COVID-19 represents a threat for frailty patients. This study compares molnupiravir and nirmatrelvir for fragile COVID- 19 patients' efficacy, safety, and cost. An observational, prospective study allowed us to evaluate molnupiravir’s efficacy and safety in real life, compare it to a subgroup of patients treated with nirmatrelvir-ritonavir, and analyze its cost-effectiveness. From January to December 2022, 435 patients (225 males, 220 females; median age 72 years), were enrolled; 24 patients were unvaccinated, and 280 patients had ≥2 risk factors. Molnupiravir performed better clinically and economically. Compared to literature data, in these patients, hospitalization was 2.5% vs. 6.8% (P<0.005), overall adverse effects 14,3% vs. 30.4% (P<0.0001), severe adverse effects 2.6 vs. 6.9% (P<0.001), thus involving potential total savings of about € 92.954 per patient (8% of standard of care cost). Early molnupiravir treatment helped fragile patients who partially responded to the vaccine, or with absolute contraindications to vaccination, to overcome COVID-19 without the need for hospitalization. In elderly patients with multiple pathologies and multiple drugs, molnupiravir prevents disease progression clinically and economically.

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Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk—a real-world analysis

Chou,

Lee,

Lin

et al. 2023

PeerJ

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Background With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. More importantly, the properties of anti-cholinergic drugs contribute various negative effects. This study aimed to investigate the sex difference in the association of polypharmacy, anticholinergic burden, and frailty with mortality. Methods Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment data were collected and the phenotype of frailty was determined by Fried’s criteria. Cox regression and the Kaplan–Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks. Results Of the 2,077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score, and greater anticholinergic burden were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. In frail female group, individuals with a higher anticholinergic burden (as indicated by the Anticholinergic Cognitive Burden Scale) from drug usage exhibited an elevated 5-year mortality rate. Conclusions Polypharmacy and greater anticholinergic burden, synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy and anticholinergic burden in the older population.

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Polypharmacy Management in a Gender Perspective: At the Heart of the Problem: Analysis of Major Cardiac Diseases, SARS-CoV-2 Affection and Gender Distribution in a Cohort of Patients in Internal Medicine Ward

Cited by 3 publications

References 46 publications

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

Prevention is better than healing. Clinical and economic implications of oral antiviral agents in COVID-19: a prospective study

Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk—a real-world analysis

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