Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients

Abstract

Objective To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI – Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients’ health state profiles and with short-term mortality. Results Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76–5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44–0.80). Conclusion The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients’ health state profiles.

Predicting hospital readmissions in older patients with heart failure with advanced bioinformatics tools: focus on the role of vulnerability and frailty

“…Table 1 shows some of the clinical characteristics of the patients with or without HF in the cohort of REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), a multicenter study collecting data from a large population of patients hospitalized in Internal Medicine or Geriatrics wards [ 2 , 7 ].…”

“…Looking at these profiles, therefore, the use of sophisticated techniques taking into account different aspects of complexity, such as ML, may be expected to provide valuable information for the prediction of negative outcomes, in hospitalized older patients with HF. ML may be considered as complementary to other approaches aimed to characterize the different pattern of patient complexity and multimorbility, such as cluster analysis [ 2 , 7 ].…”