Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial

Kempen, Thomas; Hedman, Anton; Hadziosmanovic, Nermin; Lindner, Karl‐Johan; Melhus, Håkan; Nielsen, Elisabet I.; Sulku, Johanna; Gillespie, Ulrika

doi:10.1111/bcp.15621

Cited by 3 publications

(16 citation statements)

References 57 publications

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“…It is not surprising that the updated model has been enhanced by the use of "polypharmacy" as a predictor, since this value was not evaluated during development of the original model and is a well-known risk factor for DRAs. [8][9][10][11] "Hypertension" was a protective factor in the original model, but is considered a risk factor, albeit a relatively small and non-significant one, in the updated model, which is in agreement with previous literature. 8 "A history of CKD" was a risk factor in the original model, but becomes a protective factor in the updated model, which is in contrast with previous literature.…”

Section: Discussionsupporting

confidence: 84%

“…There are some noteworthy differences between the original model and its updated version. It is not surprising that the updated model has been enhanced by the use of “polypharmacy” as a predictor, since this value was not evaluated during development of the original model and is a well‐known risk factor for DRAs 8–11 . “Hypertension” was a protective factor in the original model, but is considered a risk factor, albeit a relatively small and non‐significant one, in the updated model, which is in agreement with previous literature 8 .…”

Section: Discussionsupporting

confidence: 70%

“…Polypharmacy is considered a relatively strong risk factor for DRAs in the literature and was therefore seen as an additional value to the existing model, thus Model 6 was chosen as the final updated model 8–11 . Model 6 improved discriminative ability slightly (C‐statistic 0.64 [95% CI 0.59–0.70]), and calibration plots considerably.…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 summarizes the model performance for each updating method in both the 6 was chosen as the final updated model. [8][9][10][11] Model 6 improved discriminative ability slightly (C-statistic 0.64 [95% CI 0.59-0.70]), and calibration plots considerably. The model performance characteristics for different cutoff values are shown in Supplement 6, Table S4.…”

Section: Model Updatingmentioning

confidence: 99%

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Drug‐related readmissions in older hospitalized adults: External validation and updating of OPERAM DRA prediction tool

Snijders,

Kempen,

Aubert

et al. 2023

J American Geriatrics Society

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BackgroundDrug‐related readmissions (DRAs) are defined as rehospitalizations with an adverse drug event as their main or significant contributory cause. DRAs represent a major adverse health burden for older patients. A prediction model which identified older hospitalized patients at high risk of a DRA <1 year was previously developed using the OPERAM trial cohort, a European cluster randomized controlled trial including older hospitalized patients with multimorbidity and polypharmacy. This study has performed external validation and updated the prediction model consequently.MethodsThe MedBridge trial cohort (a multicenter cluster randomized crossover trial performed in Sweden) was used as a validation cohort. It consisted of 2516 hospitalized patients aged ≥65 years. Model performance was assessed by: (1) discriminative power, assessed by the C‐statistic with a 95% confidence interval (CI); (2) calibration, assessed by visual examination of the calibration plot and use of the Hosmer–Lemeshow goodness‐of‐fit test; and (3) overall accuracy, assessed by the scaled Brier score. Several updating methods were carried out to improve model performance.ResultsIn total, 2516 older patients were included in the validation cohort, of whom 582 (23.1%) experienced a DRA <1 year. In the validation cohort, the original model showed a good overall accuracy (scaled Brier score 0.03), but discrimination was moderate (C‐statistic 0.62 [95% CI 0.59–0.64]), and calibration showed underestimation of risks. In the final updated model, the predictor “cirrhosis with portal hypertension” was removed and “polypharmacy” was added. This improved the model's discriminative capability to a C‐statistic of 0.64 (95% CI 0.59–0.70) and enhanced calibration plots. Overall accuracy remained good.ConclusionsThe updated OPERAM DRA prediction model may be a useful tool in clinical practice to estimate the risk of DRAs in older hospitalized patients subsequent to discharge. Our efforts lay the groundwork for the future development of models with even better performance.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Model Updatingmentioning

confidence: 99%

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Drug‐related readmissions in older hospitalized adults: External validation and updating of OPERAM DRA prediction tool

Snijders,

Kempen,

Aubert

et al. 2023

J American Geriatrics Society

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“…A total of four studies [ 23 – 26 ] were included in the review including two prospective cohort studies [ 25 , 26 ], one retrospective cohort study [ 23 ] and one post-hoc analysis of a randomised controlled trial [ 24 ]. The studies were conducted across Sweden [ 24 , 25 ], France [ 23 ] and the UK [ 26 ], and were based in general ( n = 2) or teaching hospitals ( n = 2). The cohort sizes ranged from 390 to 2637 participants and the mean age ranged from 77 to 86 years.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis

Prasad,

Lau,

Wojt

et al. 2023

Drugs Aging

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Background Older adults are at an increased risk of drug-related problems, especially following discharge from hospital. Drug-related readmissions place a large burden on the patient and the healthcare system. However, previous studies report inconsistent results on the prevalence and associated risk factors for drug-related hospital readmissions in older adults. Objectives We aimed to assess the prevalence of drug-related readmissions in older adults aged 65 years and older and investigate the drug classes, preventability and risk factors most associated with these readmissions. Methods A systematic review and meta-analysis were undertaken to answer our objectives. A search of four databases (MEDLINE, Embase, CINAHL and Scopus) was conducted. Three authors independently performed title and abstract screening, full-text screening and data extraction of all included studies. A meta-analysis was conducted to calculate the pooled prevalence of drug-related readmissions across all studies, and a subgroup analysis was performed to explore heterogeneity among studies reporting on adverse drug reaction-related readmissions. Results A total of 1978 studies were identified in the initial search, of which four studies were included in the final synthesis. Three studies focused on readmissions due to adverse drug reactions and one study focused on readmissions due to drug-related problems. A pooled prevalence of 9% (95% confidence interval 2–18) was found for drug-related readmissions across all studies, and a pooled prevalence of 6% (95% confidence interval 4–10) was found for adverse drug reaction-related readmissions. Three studies explored the preventability of readmissions and 15.4–22.2% of cases were deemed preventable. The drug classes most associated with adverse drug reaction readmissions included anticoagulants, antibiotics, psychotropics and chemotherapy agents. Polypharmacy (the use of five or more medications) and several comorbidities such as cancer, liver disease, ischaemic heart disease and peptic ulcer disease were identified as risk factors for drug-related readmissions. Conclusions Almost one in ten older adults discharged from hospital experienced a drug-related hospital readmission, with one fifth of these deemed preventable. Several comorbidities and the use of polypharmacy and high-risk drugs were identified as prominent risk factors for readmission. Further research is needed to explore possible causes of drug-related readmissions in older adults for a more guided approach to the development of effective medication management interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01076-8.

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Review on Emerging Therapeutic Strategies for Managing Cardiovascular Disease

Narkhede,

Pardeshi,

Bhagat

et al. 2024

CCR

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Cardiovascular disease (CVD) remains a foremost global health concern, necessitating ongoing exploration of innovative therapeutic strategies. This review surveys the latest developments in cardiovascular therapeutics, offering a comprehensive overview of emerging approaches poised to transform disease management. The examination begins by elucidating the current epidemiological landscape of CVD and the economic challenges it poses to healthcare systems. It proceeds to scrutinize the limitations of traditional therapies, emphasizing the need for progressive interventions. The core focus is on novel pharmacological interventions, including advancements in drug development, targeted therapies, and repurposing existing medications. The burgeoning field of gene therapy and its potential in addressing genetic predispositions to cardiovascular disorders are explored, alongside the integration of artificial intelligence and machine learning in risk assessment and treatment optimization. Non-pharmacological interventions take center stage, with an exploration of digital health technologies, wearable devices, and telemedicine as transformative tools in CVD management. Regenerative medicine and stem cell therapies, offering promises of tissue repair and functional recovery, are investigated for their potential impact on cardiac health. This review also delves into the interplay of lifestyle modifications, diet, exercise, and behavioral changes, emphasizing their pivotal role in cardiovascular health and disease prevention. As precision medicine gains prominence, this synthesis of emerging therapeutic modalities aims to guide clinicians and researchers in navigating the dynamic landscape of cardiovascular disease management, fostering a collective effort to alleviate the global burden of CVD and promote a healthier future.

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Risk factors for and preventability of drug‐related hospital revisits in older patients: A post‐hoc analysis of a randomized clinical trial

Cited by 3 publications

References 57 publications

Drug‐related readmissions in older hospitalized adults: External validation and updating of OPERAM DRA prediction tool

Drug‐related readmissions in older hospitalized adults: External validation and updating of OPERAM DRA prediction tool

Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis

Review on Emerging Therapeutic Strategies for Managing Cardiovascular Disease

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