Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments
Background: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency depart...
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Frontiers Media S.A.
2021-01-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2020.611102/full |
| _version_ | 1818415974818250752 |
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| author | Giada Crescioli Giada Crescioli Alessandra Bettiol Roberto Bonaiuti Roberto Bonaiuti Marco Tuccori Marco Tuccori Marco Rossi Annalisa Capuano Silvia Pagani Giulia Spada Mauro Venegoni Giuseppe Danilo Vighi Guido Mannaioni Guido Mannaioni Alfredo Vannacci Alfredo Vannacci Alfredo Vannacci Niccolò Lombardi Niccolò Lombardi Niccolò Lombardi MEREAFaPS Study group |
| author_facet | Giada Crescioli Giada Crescioli Alessandra Bettiol Roberto Bonaiuti Roberto Bonaiuti Marco Tuccori Marco Tuccori Marco Rossi Annalisa Capuano Silvia Pagani Giulia Spada Mauro Venegoni Giuseppe Danilo Vighi Guido Mannaioni Guido Mannaioni Alfredo Vannacci Alfredo Vannacci Alfredo Vannacci Niccolò Lombardi Niccolò Lombardi Niccolò Lombardi MEREAFaPS Study group |
| author_sort | Giada Crescioli |
| collection | DOAJ |
| description | Background: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency department (ED) visits in the elderly Italian patients according to different age groups, and to evaluate the risk of hospitalization associated to ADEs in this population.Methods: A multicentre, retrospective study was performed on reports of suspected ADEs collected between 2007–2018 in 94 EDs involved in the MEREAFaPS Study. Elderly patients who experienced one or more CV medications-related ADEs leading to ED visit were selected. Patients’ characteristics, suspected (ATC classes B and C) and concomitant drugs, and ADE description were collected. Elderly patients were stratified into three age groups (65–74, 75–84, and ≥85 years) and compared to adults (18–64 years). Logistic regression analyses were used to estimate the reporting odds ratios (RORs) with 95% confidence intervals (CIs) of ADE-related hospitalization adjusting for sex, presence of two or more suspected drugs, concomitant drugs, and one or more comorbidities.Results: Among elderly, 16,926 reports of suspected ADE related to CV medications were collected, and 6,694 (39.5%) resulted in hospitalization. Patients were mostly female, Caucasians, and middle-old (75–84). 78.9% of patients were treated with only one suspected drug, and 71.9% and 47.1% reported concomitant medications and comorbidities, respectively. Compared to adults, risk of hospitalization was significantly higher for middle-old and oldest-old patients exposed to vitamin K antagonists (1.29 [1.09–1.52] and 1.56 [1.30–187]), direct thrombin inhibitors (3.41 [1.44–8.08] and 4.12 [1.67–10.17]), antiplatelets (1.51 [1.26–1.81] and 2.09 [1.71–2.57]), and beta-blockers (1.89 [1.38–2.59 and 2.31 [1.60–3.35]). Overall, a higher risk of hospitalization was observed for renin-angiotensin system inhibitors (1.32 [1.04–1.68], 1.65 [1.32–2.06], and 2.20 [1.70–2.85]), presence of two or more concomitant drugs, and concomitant conditions.Conclusion: Our real-world findings underline relevant safety aspects of CV medications in the elderly Italian population. ED clinicians must always consider the higher risk of hospitalization related to the use of CV drugs in elderly, particularly in oldest-old ones, for antiarrhythmics, beta-blocking agents, renin-angiotensin system inhibitors, antiplatelets, and anticoagulants. |
| first_indexed | 2024-12-14T11:43:31Z |
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| id | doaj.art-626697ecfa0a4a7b8aa3ad5bb6dae11a |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-14T11:43:31Z |
| publishDate | 2021-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-626697ecfa0a4a7b8aa3ad5bb6dae11a2022-12-21T23:02:42ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-01-011110.3389/fphar.2020.611102611102Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency DepartmentsGiada Crescioli0Giada Crescioli1Alessandra Bettiol2Roberto Bonaiuti3Roberto Bonaiuti4Marco Tuccori5Marco Tuccori6Marco Rossi7Annalisa Capuano8Silvia Pagani9Giulia Spada10Mauro Venegoni11Giuseppe Danilo Vighi12Guido Mannaioni13Guido Mannaioni14Alfredo Vannacci15Alfredo Vannacci16Alfredo Vannacci17Niccolò Lombardi18Niccolò Lombardi19Niccolò Lombardi20MEREAFaPS Study groupDepartment of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, ItalyTuscan Regional Center of Pharmacovigilance, Florence, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, ItalyJoint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, Florence, ItalyTuscan Regional Center of Pharmacovigilance, Florence, ItalyUnit of Adverse Drug Reactions Monitoring, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyTuscan Regional Center of Pharmacovigilance, Florence, ItalyCampania Regional Center for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli,” Naples, ItalyInternal Medicine, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, ItalyHospital Pharmacy, Vimercate Hospital, ASST Vimercate, Vimercate, ItalyRegional Center for Pharmacovigilance, Milan, ItalyInternal Medicine, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy0Toxicology Unit and Poison Center, Careggi University Hospital, Florence, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, ItalyTuscan Regional Center of Pharmacovigilance, Florence, ItalyJoint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, Florence, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, ItalyTuscan Regional Center of Pharmacovigilance, Florence, Italy0Toxicology Unit and Poison Center, Careggi University Hospital, Florence, ItalyBackground: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency department (ED) visits in the elderly Italian patients according to different age groups, and to evaluate the risk of hospitalization associated to ADEs in this population.Methods: A multicentre, retrospective study was performed on reports of suspected ADEs collected between 2007–2018 in 94 EDs involved in the MEREAFaPS Study. Elderly patients who experienced one or more CV medications-related ADEs leading to ED visit were selected. Patients’ characteristics, suspected (ATC classes B and C) and concomitant drugs, and ADE description were collected. Elderly patients were stratified into three age groups (65–74, 75–84, and ≥85 years) and compared to adults (18–64 years). Logistic regression analyses were used to estimate the reporting odds ratios (RORs) with 95% confidence intervals (CIs) of ADE-related hospitalization adjusting for sex, presence of two or more suspected drugs, concomitant drugs, and one or more comorbidities.Results: Among elderly, 16,926 reports of suspected ADE related to CV medications were collected, and 6,694 (39.5%) resulted in hospitalization. Patients were mostly female, Caucasians, and middle-old (75–84). 78.9% of patients were treated with only one suspected drug, and 71.9% and 47.1% reported concomitant medications and comorbidities, respectively. Compared to adults, risk of hospitalization was significantly higher for middle-old and oldest-old patients exposed to vitamin K antagonists (1.29 [1.09–1.52] and 1.56 [1.30–187]), direct thrombin inhibitors (3.41 [1.44–8.08] and 4.12 [1.67–10.17]), antiplatelets (1.51 [1.26–1.81] and 2.09 [1.71–2.57]), and beta-blockers (1.89 [1.38–2.59 and 2.31 [1.60–3.35]). Overall, a higher risk of hospitalization was observed for renin-angiotensin system inhibitors (1.32 [1.04–1.68], 1.65 [1.32–2.06], and 2.20 [1.70–2.85]), presence of two or more concomitant drugs, and concomitant conditions.Conclusion: Our real-world findings underline relevant safety aspects of CV medications in the elderly Italian population. ED clinicians must always consider the higher risk of hospitalization related to the use of CV drugs in elderly, particularly in oldest-old ones, for antiarrhythmics, beta-blocking agents, renin-angiotensin system inhibitors, antiplatelets, and anticoagulants.https://www.frontiersin.org/articles/10.3389/fphar.2020.611102/fullemergency departmenthospitalizationadverse drug eventcardiovascular drugelderly |
| spellingShingle | Giada Crescioli Giada Crescioli Alessandra Bettiol Roberto Bonaiuti Roberto Bonaiuti Marco Tuccori Marco Tuccori Marco Rossi Annalisa Capuano Silvia Pagani Giulia Spada Mauro Venegoni Giuseppe Danilo Vighi Guido Mannaioni Guido Mannaioni Alfredo Vannacci Alfredo Vannacci Alfredo Vannacci Niccolò Lombardi Niccolò Lombardi Niccolò Lombardi MEREAFaPS Study group Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments Frontiers in Pharmacology emergency department hospitalization adverse drug event cardiovascular drug elderly |
| title | Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments |
| title_full | Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments |
| title_fullStr | Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments |
| title_full_unstemmed | Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments |
| title_short | Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments |
| title_sort | risk of hospitalization associated with cardiovascular medications in the elderly italian population a nationwide multicenter study in emergency departments |
| topic | emergency department hospitalization adverse drug event cardiovascular drug elderly |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2020.611102/full |
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