Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study

Lin, Chih Wan; Wen, Yue; Chen, Liang Kung; Hsiao, Fei‐Yuan

doi:10.1038/srep41035

Cited by 19 publications

(18 citation statements)

References 37 publications

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“…In previous studies, the use of AEDs has been associated with elevated risk for fall (Seppala et al, 2018), stroke (Sarycheva et al, 2018), fractures (Shen et al, 2014), pneumonia (Taipale et al, 2019), and adverse drug-drug interactions (Anderson, 2004). Application of traditional AEDs (e.g., phenytoin, valproic acid) was associated with unplanned hospital admissions and impaired motor functions (Lin et al, 2017). Use of carbamazepine and oxcarbamazepine was attached to adverse cardiac events, hyponatremia, and sedation (Spina and Perucca, 2002).…”

Section: Therapeutic Aspects Current Findings and Recommendationsmentioning

confidence: 99%

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

et al. 2020

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Cognitive impairment is a common and seriously debilitating symptom of various mental and neurological disorders including autism, attention deficit hyperactivity disorder, multiple sclerosis, epilepsy, and neurodegenerative diseases, like Alzheimer's disease. In these conditions, high prevalence of epileptiform activity emerges as a common pathophysiological hallmark. Growing body of evidence suggests that this discrete but abnormal activity might have a long-term negative impact on cognitive performance due to neuronal circuitries' remodeling, altered sleep structure, pathological hippocampocortical coupling, and even progressive neuronal loss. In animal models, epileptiform activity was shown to enhance the formation of pathological amyloid and tau proteins that in turn trigger network hyperexcitability. Abolishing epileptiform discharges might slow down the cognitive deterioration. These findings might provide basis for therapeutic use of antiepileptic drugs in neurodegenerative cognitive disorders. The aim of our review is to describe the data on the prevalence of epileptiform activity in various cognitive disorders, to summarize the current knowledge of the mechanisms of epileptic activity in relation to cognitive impairment, and to explore the utility of antiepileptic drugs in the therapy of cognitive disorders. We also propose future directions for drug development and novel therapeutic interventions targeting epileptiform discharges in these disorders.

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Section: Therapeutic Aspects Current Findings and Recommendationsmentioning

confidence: 99%

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

et al. 2020

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“…Our results are in line with a previous study conducted in Asia reporting AED use to be associated with a 67% increased risk of unplanned hospitalizations (95% CI: 26%-122%) among persons aged !65 years. 13 The smaller difference in accumulated number of hospital days observed in our study between AED initiators and matched noninitiators may be due to exclusion of persons with epilepsy. In our study, AEDs were used to other indications than epilepsy, namely, treatment of neuropathic pain and BPSD.…”

Section: Discussionmentioning

confidence: 58%

“…In a case-time-control study, use of older AEDs (ie, phenytoin, phenobarbital, carbamazepine, valproic acid) was associated with unplanned hospitalizations in persons aged !65 years. 13 Carbamazepine and oxcarbazepine have been associated with cardiac adverse drug events, hyponatremia, and sedation. 3,14 In addition, carbamazepine, oxcarbazepine, phenytoin, and valproic acid have been associated with impairments of cognitive and motor functioning.…”

mentioning

confidence: 99%

Antiepileptic Drugs and Accumulation of Hospital Days Among Persons With Alzheimer's Disease

Lavikainen

Taipale

Tanskanen

et al. 2019

Journal of the American Medical Directors Association

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Objectives: To compare the accumulation of hospital days between initiators and noninitiators of antiepileptic drugs (AEDs) among persons with Alzheimer's disease (AD). Design: Exposure-matched cohort study. Setting and participants: Persons newly diagnosed with AD in 2005-2011 (n ¼ 70,718) and initiating AED use identified from Finnish health care registers. For each AED initiator, 1 noninitiator matched on age, sex, and time since AD diagnosis was selected. Persons with epilepsy were excluded from the study. Methods: Association between AED initiation or use of individual AEDs and accumulation of hospital days during a 2-year follow-up was assessed using negative binomial model. Results: AED initiators (n ¼ 4432) were hospitalized on average for 43.7 (SD: 88.3) days and matched noninitiators for 32.2 (SD: 71.3) days during the 2-year follow-up. Altogether, 27.3% of the AED initiators and 35.6% of the noninitiators had no hospital days during the study period. Number of accumulated hospital days during the follow-up was 31% higher [adjusted incidence rate ratio (aIRR): 1.31, 95% confidence interval (CI): 1.19-1.43] among AED initiators than the noninitiators. Hospital days due to diseases of the nervous system excluding dementia (aIRR: 2.72, 95% CI: 1.72-4.31), musculoskeletal system (aIRR: 2.49, 95% CI: 1.73-3.58), respiratory system (aIRR: 1.89, 95% CI: 1.47-2.43), and mental and behavioral disorders excluding dementia (aIRR: 1.96, 95% CI: 1.02-3.79) were more common among the AED initiators than noninitiators. Among pregabalin (aIRR: 0.65, 95% CI: 0.56-0.77), gabapentin (aIRR: 0.66, 95% CI: 0.49-0.88), and clonazepam (aIRR: 0.73, 95% CI: 0.55-0.96) initiators, the number of accumulated hospital days was 27% to 35% lower than the days accumulated among the initiators of valproic acid. Conclusions and implications: AED initiators had more hospital days than noninitiators. Pregabalin and gabapentin were associated with a lower number of hospital days than valproic acid. Further research is needed on the reasons for these findings.

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“…[ 14 ] Unplanned hospitalization was defined as a hospital admission after an emergency department visit. [ 15 ] ICU admission was identified as a hospital admission with use of ICU services recorded in the NHIRD. All study subjects were continuously followed from January 1, 2006 to the occurrence of each outcome or to the end of 2013, whichever came first.…”

Section: Methodsmentioning

confidence: 99%

Predicting mortality and hospitalization of older adults by the multimorbidity frailty index

2017

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BackgroundExisting operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to understand its ability to predict adverse event.MethodsThis is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included. We constructed the multimorbidity frailty index using cumulative deficit approach and categorized study population according to the multimorbidity frailty index quartiles: fit, mild frailty, moderate frailty and severe frailty. The multimorbidity frailty index included deficits from outpatient and inpatient diagnosis. Associations with all-cause mortality, unplanned hospitalization and intensive care unit admission were assessed using Kaplan-Meier curves and Cox regression analyses.ResultsThe multimorbidity frailty index incorporated 32 deficits, with mean multimorbidity frailty index score of 0.052 (standard deviation = 0.060) among 86,133 subjects included. Compared to subjects in fit category, subjects with severe frailty were associated with a 5.0-fold (adjusted hazard ratio, aHR 4.97; 95% confidence interval, 95% CI 4.49–5.50) increased risk of death at 1 year after adjusting for age and gender. Subjects with moderate frailty or mild frailty was associated with 3.1- (adjusted HR 3.08; 95% CI 2.80–3.39) or 1.9- (adjusted HR 1.86; 95% CI 1.71–2.01) folds increased risk, respectively.4.49–5.50). The risk trend of unplanned hospitalization and intensive care unit admission is similar among the study population. Besides, the association between the frailty categories and all three outcomes was slightly stronger among women.ConclusionThe multimorbidity frailty index was highly associated with all-cause mortality, unplanned hospitalization and ICU admission. It could serve as an efficient tool for stratifying older adults into different risk groups for planning care management programs.

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Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study

Cited by 19 publications

References 37 publications

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach

Antiepileptic Drugs and Accumulation of Hospital Days Among Persons With Alzheimer's Disease

Predicting mortality and hospitalization of older adults by the multimorbidity frailty index

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