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Liau SJ, Zhao M, Hamada S, Gutiérrez-Valencia M, Jadczak AD, Li L, Martínez-Velilla N, Sakata N, Fu P, Visvanathan R, Lalic S, Roncal-Belzunce V, Bell JS. Deprescribing Opportunities for Frail Residents of Nursing Homes: A Multicenter Study in Australia, China, Japan, and Spain. J Am Med Dir Assoc 2024:S1525-8610(24)00071-9. [PMID: 38423513 DOI: 10.1016/j.jamda.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Deprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain. DESIGN Secondary cross-sectional analyses of data from 4 cohort studies. SETTING AND PARTICIPANTS A total of 1142 residents in 31 nursing homes. METHODS Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts. RESULTS In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P < .001), vitamin D (nil in China to 52.7% in Australia, P < .001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P < .001), aspirin (13.5% in Japan to 26.2% in China, P < .001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P < .001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P = .010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06-1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45-2.18), aspirin (PR, 1.31; 95% CI, 1.04-1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00-1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan. CONCLUSIONS AND IMPLICATIONS There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing.
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Affiliation(s)
- Shin J Liau
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain; Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Agathe D Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services and the Basil Hetzel Institute, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Li Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Nicolás Martínez-Velilla
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Navarrabiomed, Public University of Navarra (UPNA), Pamplona, Navarre, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Navarre, Spain
| | - Nobuo Sakata
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Peipei Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services and the Basil Hetzel Institute, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Pharmacy Department, Monash Health, Melbourne, Victoria, Australia
| | - Victoria Roncal-Belzunce
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain; Navarrabiomed, Public University of Navarra (UPNA), Pamplona, Navarre, Spain
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Roncal-Belzunce V, Cedeño-Veloz BA, Elcano RSM, Gutiérrez-Valencia M, Izquieta VR, Guruceaga-Eguillor I, Marín-Epelde I, Echeverria-Beistegui I, Sánchez-Latorre M, Galbete A, Garaioa-Aramburu K, Martínez-Velilla N. Cognitive and functional trajectories in geriatric outpatients after a pharmacologic multidisciplinary intervention: A study protocol. Rev Esp Geriatr Gerontol 2023; 58:101386. [PMID: 37523939 DOI: 10.1016/j.regg.2023.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/14/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. METHODS A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients' functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR - Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients' quality of life, rate of falling, and use of healthcare resources. DISCUSSION We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. TRIAL REGISTRATION ClinicalTrials.gov: NCT05408598 (March 1, 2022).
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Affiliation(s)
- Victoria Roncal-Belzunce
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain.
| | - Bernardo Abel Cedeño-Veloz
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Itxaso Marín-Epelde
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | - Iciar Echeverria-Beistegui
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain
| | | | - Arkaitz Galbete
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain
| | | | - Nicolás Martínez-Velilla
- Geriatric Unit, Navarrabiomed, Public University of Navarra (UPNA), Navarra Health Research Institute (IdisNa), Pamplona, Navarra, Spain; Department of Geriatrics, Hospital Universitario de Navarra (HUN), Pamplona, Spain
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Maestro C, Leache L, Gutiérrez-Valencia M, Saiz LC, Gómez H, Bacaicoa MC, Erviti J. Efficacy and safety of N-acetylcysteine for preventing post-intravenous contrast acute kidney injury in patients with kidney impairment: a systematic review and meta-analysis. Eur Radiol 2023; 33:6569-6581. [PMID: 37071164 DOI: 10.1007/s00330-023-09577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES N-Acetylcysteine (NAC) may confer protection against post-contrast acute kidney injury (PC-AKI), although evidence is sparse and conflicting. The objective was to analyse the evidence on the efficacy and safety of NAC vs no administration of NAC in preventing PC-AKI in patients with pre-existing kidney impairment undergoing a non-interventional radiological examination requiring intravenous (IV) contrast media (CM) administration. METHODS We carried out a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE, and Clinicaltrials.gov up to May 2022. The primary outcome was PC-AKI. Secondary outcomes included the requirement of renal replacement therapy, all-cause mortality, serious adverse events, and length of hospital stay. We conducted the meta-analyses using the Mantel-Haenszel method and following a random-effects model. RESULTS NAC was not associated with a significant reduction in PC-AKI (RR 0.47, 95%CI 0.20 to 1.11; 8 studies; 545 participants; I2: 56%; low certainty), all-cause mortality (RR 0.67, 95%CI 0.29 to 1.54; 2 studies; 129 participants; very low certainty), or length of hospital stay (mean difference 9.2 days, 95%CI - 20.08 to 38.48; 1 study; 42 participants; very low certainty). The impact on other outcomes could not be determined. CONCLUSIONS NAC may not reduce the risk of PC-AKI or all-cause mortality in people with kidney impairment who receive an IV CM prior to radiological imaging, although the certainty of the evidence is very low or low. CLINICAL RELEVANCE STATEMENT Our review concludes that prophylactic administration of N-acetylcysteine may not significantly reduce the risk of acute kidney injury in patients with kidney impairment receiving an intravenous contrast media prior to non-interventional radiological imaging, which may support decision making in this common clinical scenario. KEY POINTS • N-Acetylcysteine may not significantly reduce the risk of acute kidney injury in patients with kidney impairment receiving an intravenous contrast media prior to non-interventional radiological imaging. • All-cause mortality and length of hospital stay would not be decreased with the administration of N-Acetylcysteine in this setting.
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Affiliation(s)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain.
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain.
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Helena Gómez
- Radiology Service, University Hospital of Navarre, Navarre Health Service, Pamplona, Navarre, Spain
| | - Maria Carmen Bacaicoa
- Radiology Service, University Hospital of Navarre, Navarre Health Service, Pamplona, Navarre, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, first floor, 31003, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Ladrón-Arana S, Orzanco-Garralda R, Escalada-Hernández P, Aguilera-Serrano C, Gutiérrez-Valencia M, Urbiola-Castillo J. Efficacy of educational interventions in adolescent population with feeding and eating disorders: a systematic review. Eat Weight Disord 2023; 28:69. [PMID: 37608142 PMCID: PMC10444681 DOI: 10.1007/s40519-023-01594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Educational interventions are a key element in the care of young patients with feeding and eating disorders, forming part of the majority of therapeutic approaches. The aim of this review is to evaluate the impact of educational interventions in adolescents with feeding and eating disorders. METHODS Following the PRISMA recommendations electronic databases were searched up to 29 June 2023. Studies related to educational interventions in young population diagnosed with feeding and eating disorders (anorexia nervosa, avoidant/restrictive food intake disorder, bulimia nervosa, pica and ruminative disorders and binge- eating disorder) in Spanish and English language, without temporal limitation, were located in the databases: PubMed, Scopus, CINAHL, Cochrane Library, PsycINFO, CUIDEN, DIALNET, and ENFISPO. A search in the databases of grey literature was performed in OpenGrey and Teseo. The review protocol was registered in PROSPERO (CRD42020167736). RESULTS A total of 191 articles were selected from the 9744 citations screened. Ten publications were included. The results indicated variability between educational programs, including individual and group interventions, learning techniques and various research methodologies. Variables such as learning, attitudinal and perceptual changes, anthropometric parameters, symptom improvement, normalization of eating patterns, evaluation of the program and cognitive flexibility were identified. The risk of bias was high due to the low methodological quality of a large number of studies analyzed. CONCLUSION The results indicate that educational interventions can influence the improvement of knowledge level and have a positive effect on health outcomes. Although education is a common practice in the treatment of these pathologies, high-quality studies were not identified. Thus, this review concludes that additional evidence is needed to evaluate the effectiveness of educational programs, with further research studies, especially randomized controlled trials, to confirm these results. LEVEL OF EVIDENCE Level I: Systematic review.
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Affiliation(s)
| | - Rosario Orzanco-Garralda
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain, S/N-31008, Pamplona, Navarre, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain, S/N-31008, Pamplona, Navarre, Spain.
- Navarra Institute for Health Research (IdisNA), Pamplona, Spain.
| | | | - Marta Gutiérrez-Valencia
- Navarra Institute for Health Research (IdisNA), Pamplona, Spain
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
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5
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Salazar J, Bracchiglione J, Savall-Esteve O, Antequera A, Bottaro-Parra D, Gutiérrez-Valencia M, Martínez-Peralta S, Pericay C, Tibau A, Bonfill X. Treatment with anticancer drugs for advanced pancreatic cancer: a systematic review. BMC Cancer 2023; 23:748. [PMID: 37573294 PMCID: PMC10422698 DOI: 10.1186/s12885-023-11207-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Patients with advanced pancreatic cancer have a poor prognosis and high burden of cancer-related symptoms. It is necessary to assess the trade-off of clinical benefits and possible harms of treatments with anticancer drugs (TAD). This systematic review aims to compare the effectiveness of TAD versus supportive care or no treatment, considering all patient-important outcomes. METHODS We searched PubMed, Embase, Cochrane Library, and Epistemonikos. Two reviewers performed selection, data extraction and risk of bias assessment. We assessed certainty of the evidence using the GRADE approach. RESULTS We included 14 randomised controlled trials. Chemotherapy may result in a slight increase in overall survival (MD: 2.97 months (95%CI 1.23, 4.70)) and fewer hospital days (MD: -6.7 (-8.3, -5.1)), however, the evidence is very uncertain about its effect on symptoms, quality of life, functional status, and adverse events. Targeted/biological therapy may result in little to no difference in overall survival and a slight increment in progression-free survival (HR: 0.83 (95%CI 0.63, 1.10)), but probably results in more adverse events (RR: 5.54 (95%CI 1.24, 23.97)). The evidence is very uncertain about the effect of immunotherapy in overall survival and functional status. CONCLUSIONS The evidence is very uncertain about whether the benefits of using treatment with anticancer drugs outweigh their risks for patients with advanced pancreatic cancer. This uncertainty is further highlighted when considering immunotherapy or a second line of chemotherapy and thus, best supportive care would be an appropriate alternative. Future studies should assess their impact on all patient-important outcomes to inform patients in setting their goals of care.
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Affiliation(s)
- Josefina Salazar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Barcelona, Spain
- Interdisciplinary Centre for Health Studies CIESAL, Universidad de Valparaíso, Viña del Mar, Chile
| | - Olga Savall-Esteve
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - David Bottaro-Parra
- Unitat de Cures Pal·Liatives de L'Institut d'Oncologia de La Catalunya Sud, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Carles Pericay
- Servicio de Oncología Médica, Fundació Assistencial Mûtua Terrassa, Terrassa - Barcelona, Spain
| | - Ariadna Tibau
- Oncology Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
- Universitat Autònoma Barcelona, Barcelona, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
- CIBER Epidemiología Y Salud Pública (CIBERESP), Barcelona, Spain.
- Universitat Autònoma Barcelona, Barcelona, Spain.
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Letter: Albumin-Does formulation matter? Authors' reply. Aliment Pharmacol Ther 2023; 57:1484-1485. [PMID: 37243460 DOI: 10.1111/apt.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Calvo DM, Saiz LC, Leache L, Celaya MC, Gutiérrez-Valencia M, Alonso A, Erviti J, Alzueta N, Echeverría A, Garjón J, Fontela C, Sanz L, Acín MT, Fernández ML, Gómez N. Effect of the combination of diuretics, renin-angiotensin-aldosterone system inhibitors, and non-steroidal anti-inflammatory drugs or metamizole (triple whammy) on hospitalisation due to acute kidney injury: a nested case-control study. Pharmacoepidemiol Drug Saf 2023. [PMID: 36960493 DOI: 10.1002/pds.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Concomitant use of diuretics, renin-angiotensin-aldosterone system (RAAS) inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizole, known as "triple whammy" (TW), has been associated with an increased risk of acute kidney injury (AKI). Nevertheless, there is still uncertainty on its impact in hospitalisation and mortality. The aim of the study was to analyse the association between exposure to TW and the risk of hospitalisation for AKI, all-cause mortality and the need for renal replacement therapy (RRT). METHODS A case-control study nested in a cohort of adults exposed to at least one diuretic or RAAS inhibitor between 2009-2018 was carried out within the Pharmacoepidemiological Research Database for Public Health Systems (BIFAP). Patients hospitalised for AKI between 2010-2018 (cases) were matched with up to 10 patients of the same age, sex and region of Spain who had not been hospitalised for AKI as of the date of hospitalisation for AKI of the matching case (controls). The association between TW exposure vs non-exposure to TW and outcome variables was analysed using logistic regression models. RESULTS A total of 480,537 participants (44,756 cases and 435,781 controls) were included (mean age: 79 years). The risk of hospitalisation for AKI was significantly higher among those exposed to TW [adjusted odds ratio (aOR) 1.36, 95% confidence interval (95%CI) 1.32-1.40], being higher with current (aOR 1.60, 95%CI 1.52-1.69) and prolonged exposure (aOR 1.65, 95%CI 1.55-1.75). No significant association was found with the need of RRT. Unexpectedly, mortality was lower in those exposed to TW [aOR 0.81, 95%CI 0.71-0.93], which may be influenced by other causes. CONCLUSION Vigilance should be increased when diuretics, RAAS inhibitors, and NSAIDs or metamizole are used concomitantly, especially in patients at risk such as elderly patients.
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Affiliation(s)
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Concepción Celaya
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Natalia Alzueta
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Amaya Echeverría
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Javier Garjón
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Carmen Fontela
- Pharmacy Service. Donostia University Hospital, OSI Donostialdea, Osakidetza, San Sebastián, Spain
| | - Lorea Sanz
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Teresa Acín
- Subdirectorate of Pharmacy and Health Benefits, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Maria Loreto Fernández
- Nephrology Service, Navarre University Hospital, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
| | - Nerea Gómez
- Nephrology Service, Navarre University Hospital, Navarre Health Service, Pamplona, Spain. Navarra Health Research Institute (IdiSNA)
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis. Aliment Pharmacol Ther 2023; 57:620-634. [PMID: 36524316 DOI: 10.1111/apt.17344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. MATERIALS AND METHODS We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed. RESULTS Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL. CONCLUSION Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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9
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Saiz LC, Erviti J, Leache L, Gutiérrez-Valencia M. Restoring Study PRGF: a randomized clinical trial on plasma rich in growth factors for knee osteoarthritis. Trials 2023; 24:37. [PMID: 36653802 PMCID: PMC9850713 DOI: 10.1186/s13063-022-07049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A randomized clinical trial assessing plasma rich in growth factors (PRGF) versus hyaluronic acid for knee osteoarthritis was published in 2012 (sponsor trial ID BTI-01-EC/07/ART). Evidence of misreporting was discovered following access to unpublished materials. In accordance with the principles of the Restoring Invisible and Abandoned Trials (RIAT) initiative, we sought to re-analyse Study PRGF based on the unpublished trial materials. METHODS Reanalysis was made possible primarily based on two unpublished study documents (original trial protocol and final report) obtained from the authors of the original publication. A call to action, calling on the authors to correct the original publication, was publicly issued. The involved ethics committee was repeatedly approached and extensive discussion with the authors ensued. After no agreement to correct the paper was reached, we embarked on this restoration. Reanalysis was focused on providing updated analyses for efficacy and safety. RESULTS The efficacy of PRGF was not statistically different from hyaluronic acid for any prespecified primary or secondary efficacy outcomes. For the primary endpoint, the percent of patients on PRGF compared to hyaluronic acid with a decrease >40% in WOMAC pain subscale score was 5.4% higher; 95% confidence interval (CI) -10.4% to 21.3%; p = 0.505. This differs from the original publication that reported a non-prespecified primary endpoint (decrease >50% in WOMAC pain subscale score) which was 14.1% higher; 95% CI 0.5 to 27.6%; p=0.044. Furthermore, in contrast to the article statement that all the adverse events disappeared in 48 h, at least two patients in the hyaluronic arm and five patients in the PRGF arm reported persistent adverse events. Inadequate disclosure of conflicts of interest in the original publication was also noted. CONCLUSIONS This reanalysis of Study PRGF found no clinically or statistically significant benefit from PRGF compared to hyaluronic acid. The restoration of Study PRGF shows the urgency of important changes to trial reporting and oversight practices. In the future, timely access to all clinical trial documents is needed to minimize the risk of reporting bias. Similarly, ethics committees should be ready to intervene whenever a case of potential misconduct arises. TRIAL REGISTRATION This is a RIAT project, whose original trial was approved and registered on 19 December 2007 by the Ethics Committee of the Basque Country, Spain, as BTI-01-EC/07/ART.
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Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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Saiz LC, Leache L, Gutiérrez-Valencia M, Erviti J, Rojas Reyes MX. Efficacy and safety of chimeric antigen receptor T-cell (CAR-T) therapy in hematologic malignancies: a living systematic review on comparative studies. Ther Adv Hematol 2023; 14:20406207231168211. [PMID: 37138698 PMCID: PMC10150428 DOI: 10.1177/20406207231168211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/05/2023] [Indexed: 05/05/2023] Open
Abstract
Background Chimeric antigen receptor T-cell (CAR-T) cell therapies have been claimed to be curative in responsive patients. Nonetheless, response rates can vary according to different characteristics, and these therapies are associated with important adverse events such as cytokine release syndrome, neurologic adverse events, and B-cell aplasia. Objectives This living systematic review aims to provide a timely, rigorous, and continuously updated synthesis of the evidence available on the role of CAR-T therapy for the treatment of patients with hematologic malignancies. Design A systematic review with meta-analysis of randomized controlled trials (RCTs) and comparative non-randomized studies of interventions (NRSI), evaluating the effect of CAR-T therapy versus other active treatments, hematopoietic stem cell transplantation, standard of care (SoC) or any other intervention, was performed in patients with hematologic malignancies. The primary outcome is overall survival (OS). Certainty of the evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Data sources and Methods Searches were performed in the Epistemonikos database, which collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. A manual search was also carried out. We included the evidence published up to 1 July 2022. Results We included the evidence published up to 1 July 2022. We considered 139 RCTs and 1725 NRSI as potentially eligible. Two RCTs (N = 681) comparing CAR-T therapy with SoC in patients with recurrent/relapsed (R/R) B-cell lymphoma were included. RCTs did not show statistical differences in OS, serious adverse events, or total adverse events with grade ⩾ 3. Higher complete response with substantial heterogeneity [risk ratio = 1.59; 95% confidence interval (CI) = (1.30-1.93); I 2 = 89%; 2 studies; 681 participants; very low certainty evidence] and higher progression-free survival [hazard ratio for progression or death = 0.49; 95% CI = (0.37-0.65); 1 study; 359 participants; moderate certainty evidence] were reported with CAR-T therapies. Nine NRSI (N = 540) in patients with T or B-cell acute lymphoblastic leukemia or R/R B-cell lymphoma were also included, providing secondary data. In general, the GRADE certainty of the evidence for main outcomes was mostly low or very low. Conclusion So far, assuming important limitations in the level of certainty due to scarce and heterogenous comparative studies, CAR-T therapies have shown some benefit in terms of progression-free survival, but no overall survival, in patients with R/R B-cell lymphoma. Despite one-arm trials have already facilitated approval of CAR-T cell treatments, additional evidence from large comparative studies is still needed to better characterize the benefit-harm ratio of the use of CAR-T in a variety of patient populations with hematological malignancies. Registration https://doi.org/10.12688/openreseurope.14390.1. PROSPERO/OSF Preregistration 10.17605/OSF.IO/V6HDX.
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Affiliation(s)
| | - Leire Leache
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre
Health Service, Pamplona, Spain; Navarra Institute for Health Research
(IdiSNA), Pamplona, Spain
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11
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Saiz LC, Leache L, Gutiérrez-Valencia M, Erviti J. Is chimaeric antigen receptor T-cell therapy really superior to standard of care as second-line therapy for large B-cell lymphoma? Br J Haematol 2023; 200:e6-e7. [PMID: 36281751 DOI: 10.1111/bjh.18505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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12
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Erviti J, Wright J, Bassett K, Ben-Eltriki M, Jauca C, Saiz LC, Leache L, Gutiérrez-Valencia M, Perry TL. Restoring mortality data in the FOURIER cardiovascular outcomes trial of evolocumab in patients with cardiovascular disease: a reanalysis based on regulatory data. BMJ Open 2022; 12:e060172. [PMID: 36585131 PMCID: PMC9809302 DOI: 10.1136/bmjopen-2021-060172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The FOURIER trial showed a benefit of the PCSK9 inhibitor evolocumab over placebo with respect to cardiovascular outcomes in patients with cardiovascular disease. However, we observed some inconsistencies between the information in the Clinical Study Report (CSR) and that in the 2017 primary trial results publication. We aimed to restore the mortality data in the FOURIER trial based on the information contained in the death narratives in the CSR. METHODS Mortality data in the primary results publication were compared with that in the CSR. In cases of discrepancy between the sources, an independent committee blindly readjudicated and restored the cause of death according to the information in the CSR narratives. RESULTS For 360/870 deaths (41.4%), the cause of death adjudicated by the FOURIER clinical events committee differed from that declared by the local clinical investigator. When comparing the CSR information with the 2017 primary results publication, we found 11 more deaths from myocardial infarction in the evolocumab group (36 vs 25) and 3 less deaths in the placebo group (27 vs 30, respectively). In the CSR, the number of deaths due to cardiac failure in the evolocumab group was almost double those in the placebo group (31 vs 16). While cardiac and vascular deaths were not assessed as separate outcomes in the original trial analysis, after readjudication, we noted that cardiac deaths were numerically, but non-significantly, higher in the evolocumab group (113) than in the placebo group (88; relative risk (RR) 1.28, 95% CI 0.97 to 1.69, p=0.078), whereas non-cardiac vascular deaths were similar between groups (37 in each; RR 1.00, 95% CI 0.63 to 1.58, p=0.999). The reported HR for cardiovascular mortality in the original trial analysis was 1.05 (95% CI 0.88 to 1.25); after readjudication, we found a greater (although still non-significant) relative increase in cardiovascular mortality in the evolocumab treatment group (RR 1.20, 95% CI 0.95 to 1.51, p=0.13). CONCLUSION After readjudication, deaths of cardiac origin were numerically higher in the evolocumab group than in the placebo group in the FOURIER trial, suggesting possible cardiac harm. At the time the trial was terminated early, a non-significantly higher risk of cardiovascular mortality was observed with evolocumab, which was numerically greater in our readjudication. A complete restoration of the FOURIER trial data is required. In the meantime, clinicians should be sceptical about prescribing evolocumab for patients with established atherosclerotic cardiovascular disease. TRIAL REGISTRATION NUMBERS NCT01764633.
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Affiliation(s)
- Juan Erviti
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - James Wright
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ken Bassett
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohamed Ben-Eltriki
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciprian Jauca
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Luis Carlos Saiz
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Leire Leache
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Innovation and Organization Unit, Navarre Health Service, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Thomas L Perry
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Leache L, Gutiérrez-Valencia M, Enguita-Germán M, Librero J, Gorricho J, Jericó C, García-Erce JA. COVID-19 infection and complications according to ABO blood group in the elderly: A population-based subcohort and meta-analysis. Vox Sang 2022; 117:1230-1234. [PMID: 35843888 PMCID: PMC9349979 DOI: 10.1111/vox.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES It is reported that ABO antibodies have a role in COVID-19 infection and severity; however, ABO antibody titres vary with advanced age. The aim was to analyse the association between ABO blood group and risk of COVID-19 infection and complications in elderly patients, and to contrast this data with findings in the overall adult population. MATERIALS AND METHODS A prospective cohort study of the Navarre (Spain) population aged ≥60 years and a meta-analysis of published studies including participants of ≥60 years were carried out. RESULTS In the Navarre elderly population, a higher risk of COVID-19 infection was identified in the A versus non-A and O group and lower risk in O versus non-O, with no significant association between hospitalization, intensive care unit admission or mortality and any of the blood groups, results that coincide with those of the overall Navarre adult population. The meta-analyses using studies that included participants of ≥60 years demonstrated a higher risk of hospitalization and mortality in A versus non-A and a lower mortality risk with B versus non-B. Similar mortality results were found in the meta-analyses of the overall adult population. CONCLUSION There are no relevant differences between the overall adult population and population aged ≥60 years in the risk of COVID-19 infection and severity according to ABO blood groups, suggesting that age-related changes in ABO would be of limited clinical significance.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mónica Enguita-Germán
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Javier Gorricho
- Service of Evaluation and Dissemination of Results, Navarre Health Service, Pamplona, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Jose Antonio García-Erce
- Blood and Tissue Bank of Navarre, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Sciences Institute (IACS), Zaragoza, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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14
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Enguita-Germán M, Librero J, Leache L, Gutiérrez-Valencia M, Tamayo I, Jericó C, Gorricho J, García-Erce JA. Role of the AB0 blood group in COVID-19 infection and complications: A population-based study. Transfus Apher Sci 2022; 61:103357. [PMID: 35148968 PMCID: PMC8762836 DOI: 10.1016/j.transci.2022.103357] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern Spain) with no history of SARS-CoV-2 infection and with known ABO blood group, after one year of the pandemic (May 2020 - May 2021). The risk of infection, hospitalization, Intensive Care Unit (ICU) admission and death was analyzed using multivariate logistic regression, adjusting for possible confounding variables. A lower risk of infection was observed in group 0 vs non-0 groups [OR 0.94 (95 %CI 0.90-0.99)], a higher risk of infection in group A vs non-A groups [OR 1.09 (95 %CI 1.04-1.15)] and a higher risk of infection in group A vs group 0 [OR 1.08 (95CI 1.03-1.14)] (when the 4 groups are analyzed separately). No association was observed between blood groups and hospitalization, ICU admission, or death in SARS-CoV-2 infected subjects. Regarding the risk of SARS-CoV-2 infection, we observed a protective role of group O and a greater risk in the A group.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Julián Librero
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Spain.
| | | | - Ibai Tamayo
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Javier Gorricho
- Servicios de Evaluación y Difusión de Resultados, Servicio Navarro de Salud-Osasunbidea, Spain.
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Grupo idiPAZ de «Investigación en PBM», Madrid, Spain.
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Gutiérrez-Valencia M, Leache L, Saiz LC. [Review of the validity of fall risk assessment scales in hospitalised patients]. Rev Esp Geriatr Gerontol 2022; 57:186-194. [PMID: 35589476 DOI: 10.1016/j.regg.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/23/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
Falls in the hospital setting are a major health problem due to their high prevalence and their physical, functional, psychological or economic consequences. Since 1990s, different fall risk assessment scales have been developed to detect high-risk patients, which are also applied in the hospital setting. The aim of this review is to analyse the validity of different scales for assessing fall risk in adults in the hospital setting, especially in elderly patients. Following a literature search in April 2021, 36 primary studies were found that analysed the validity of the Downton, Morse, HendrichII, Stratify and Tinetti scales. Meta-analyses of sensitivity and specificity showed a high heterogeneity that does not allow recommending a specific tool that can be considered as standard in acute inpatients.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | - Luis Carlos Saiz
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, España
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Cedeno-Veloz BA, Erviti Lopez J, Gutiérrez-Valencia M, Leache Alegría L, Saiz LC, Rodríguez García AM, Sánchez Latorre M, Ramírez Vélez R, Izquierdo M, Martínez-Velilla N. Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Nutr Health Aging 2022; 26:778-785. [PMID: 35934822 DOI: 10.1007/s12603-022-1825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults. DESIGN a systematic review and meta-analysis of randomized clinical trials. SETTING AND PARTICIPANTS older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included. METHODS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool. RESULTS A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns. CONCLUSIONS Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.
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Affiliation(s)
- B A Cedeno-Veloz
- Bernardo Abel Cedeño Veloz, MD, Geriatric Department (Hospital Universitario de Navarra), Irunlarrea Street 4, 31008 Pamplona, Navarra, Spain, E-mail:
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Leache L, Gutiérrez-Valencia M, Finizola RM, Infante E, Finizola B, Pardo Pardo J, Flores Y, Granero R, Arai KJ. Pharmacotherapy for hypertension-induced left ventricular hypertrophy. Cochrane Database Syst Rev 2021; 10:CD012039. [PMID: 34628642 PMCID: PMC8502530 DOI: 10.1002/14651858.cd012039.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hypertension is the leading preventable risk factor for cardiovascular disease and premature death worldwide. One of the clinical effects of hypertension is left ventricular hypertrophy (LVH), a process of cardiac remodelling. It is estimated that over 30% of people with hypertension also suffer from LVH, although the prevalence rates vary according to the LVH diagnostic criteria. Severity of LVH is associated with a higher prevalence of cardiovascular disease and an increased risk of death. The role of antihypertensives in the regression of left ventricular mass has been extensively studied. However, uncertainty exists regarding the role of antihypertensive therapy compared to placebo in the morbidity and mortality of individuals with hypertension-induced LVH. OBJECTIVES To assess the effect of antihypertensive pharmacotherapy compared to placebo or no treatment on morbidity and mortality of adults with hypertension-induced LVH. SEARCH METHODS Cochrane Hypertension's Information Specialist searched the following databases for studies: Cochrane Hypertension Specialised Register (to 26 September 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2020, Issue 9), Ovid MEDLINE (1946 to 22 September 2020), and Ovid Embase (1974 to 22 September 2020). We searched the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov for ongoing trials. We also searched Epistemonikos (to 19 February 2021), LILACS BIREME (to 19 February 2021), and Clarivate Web of Science (to 26 February 2021), and contacted authors and funders of the identified trials to obtain additional information and individual participant data. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) with at least 12 months' follow-up comparing antihypertensive pharmacological therapy (monotherapy or in combination) with placebo or no treatment in adults (18 years of age or older) with hypertension-induced LVH were eligible for inclusion. The trials must have analysed at least one primary outcome (all-cause mortality, cardiovascular events, or total serious adverse events) to be considered for inclusion. DATA COLLECTION AND ANALYSIS Two review authors screened the search results, with any disagreements resolved by consensus amongst all review authors. Two review authors carried out the data extraction and analyses. We assessed risk of bias of the included studies following Cochrane methodology. We used the GRADE approach to assess the certainty of the body of evidence. MAIN RESULTS We included three multicentre RCTs. We selected 930 participants from the included studies for the analyses, with a mean follow-up of 3.8 years (range 3.5 to 4.3 years). All of the included trials performed an intention-to-treat analysis. We obtained evidence for the review by identifying the population of interest from the trials' total samples. None of the trials provided information on the cause of LVH. The intervention varied amongst the included trials: hydrochlorothiazide plus triamterene with the possibility of adding alpha methyldopa, spironolactone, or olmesartan. Placebo was administered to participants in the control arm in two trials, whereas participants in the control arm of the remaining trial did not receive any add-on treatment. The evidence is very uncertain regarding the effect of additional antihypertensive pharmacological therapy compared to placebo or no treatment on mortality (14.3% intervention versus 13.6% control; risk ratio (RR) 1.02, 95% confidence interval (CI) 0.74 to 1.40; 3 studies; 930 participants; very low-certainty evidence); cardiovascular events (12.6% intervention versus 11.5% control; RR 1.09, 95% CI 0.77 to 1.55; 3 studies; 930 participants; very low-certainty evidence); and hospitalisation for heart failure (10.7% intervention versus 12.5% control; RR 0.82, 95% CI 0.57 to 1.17; 2 studies; 915 participants; very low-certainty evidence). Although both arms yielded similar results for total serious adverse events (48.9% intervention versus 48.1% control; RR 1.02, 95% CI 0.89 to 1.16; 3 studies; 930 participants; very low-certainty evidence) and total adverse events (68.3% intervention versus 67.2% control; RR 1.07, 95% CI 0.86 to 1.34; 2 studies; 915 participants), the incidence of withdrawal due to adverse events may be significantly higher with antihypertensive drug therapy (15.2% intervention versus 4.9% control; RR 3.09, 95% CI 1.69 to 5.66; 1 study; 522 participants; very low-certainty evidence). Sensitivity analyses limited to blinded trials, trials with low risk of bias in core domains, and trials with no funding from the pharmaceutical industry did not change the results of the main analyses. Limited evidence on the change in left ventricular mass index prevented us from drawing any firm conclusions. AUTHORS' CONCLUSIONS We are uncertain about the effects of adding additional antihypertensive drug therapy on the morbidity and mortality of participants with LVH and hypertension compared to placebo. Although the incidence of serious adverse events was similar between study arms, additional antihypertensive therapy may be associated with more withdrawals due to adverse events. Limited and low-certainty evidence requires that caution be used when interpreting the findings. High-quality clinical trials addressing the effect of antihypertensives on clinically relevant variables and carried out specifically in individuals with hypertension-induced LVH are warranted.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | - Rosa M Finizola
- Unit of Special Projects, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Elizabeth Infante
- Unit of Systems, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Bartolome Finizola
- General Coordination, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | - Jordi Pardo Pardo
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Yris Flores
- Echocardiography Department and Cardiac Tomography Department, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
| | | | - Kaduo J Arai
- Coronary Care Unit, Cardiovascular Association Centroccidental, Barquisimeto, Venezuela
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Leache L, Arrizibita O, Gutiérrez-Valencia M, Saiz LC, Erviti J, Librero J. Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019. Int J Environ Res Public Health 2021; 18:ijerph18179208. [PMID: 34501798 PMCID: PMC8431029 DOI: 10.3390/ijerph18179208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) constitutes one of the leading mental health and behavioral disorders in childhood and adolescence. The main objective of this study was to analyze the time trend in the incidence of ADHD diagnoses in Navarre (Spain) from 2003 to 2019 in children and adolescents from 5 to 19 years old. Additionally, the seasonal trends of ADHD incidence and ADHD prevalence were determined. (2) Methods: A population-based observational retrospective study, which included people born between 1991 and 2011 and who attended compulsory education between 2007 and 2017 in Navarre (Spain), was carried out with data from both the Education and Health Department databases. (3) Results: The incidence rate increased from 4.18 cases per 1000 person-years in 2003 to 7.43 cases per 1000 person-years in 2009, before decreasing progressively to 2.1 cases per 1000 person-years in 2019. A peak incidence rate at 7–8 years of age was observed, which is consistent across the study period and for both genders. Males were more than twice as likely to be diagnosed with ADHD than females, with similar time trends in both. A seasonal pattern in ADHD diagnosis was found, with peaks in February–March and the lowest rates in the summer months. Inattentive cases were much more frequent than hyperactive cases, whereas combined cases remained low across the study period. (4) Conclusions: In this age-period-cohort analysis, a clear period and age effect was observed. We found a decreasing trend in the ADHD incidence rate since 2015. Further research is needed to confirm whether a change of trend is occurring globally.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | | | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | - Juan Erviti
- Therapeutics Initiative, Department of Anesthesiology, Pharmaceuticals and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Julián Librero
- Navarrabiomed Biomedical Research Centre, Navarre Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, Public University of Navarre (UPNA), 31008 Pamplona, Navarre, Spain
- Correspondence: ; Tel.: +34-848-428-392
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Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, van der Cammen TJM, Hartikainen S, Ilhan B, Landi F, Morrissey Y, Mair A, Gutiérrez-Valencia M, Emmelot-Vonk MH, Mora MÁC, Denkinger M, Crome P, Jackson SHD, Correa-Pérez A, Knol W, Soulis G, Gudmundsson A, Ziere G, Wehling M, O’Mahony D, Cherubini A, van der Velde N. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age Ageing 2021; 50:1189-1199. [PMID: 33349863 PMCID: PMC8244563 DOI: 10.1093/ageing/afaa249] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group. Methods STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed. Results The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes. Conclusion STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
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Affiliation(s)
- Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics (section of Geriatrics), Ghent University, Ghent, Belgium
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark and Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, Istanbul, Turkey
| | - Eva Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic and Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Şişli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Francesco Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Yvonne Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | | | - Marielle H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - María Ángeles Caballero Mora
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real and CIBER de Fragilidad y Envejecimiento Saludable, Spain
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Centre Ulm, Ulm, Germany
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Wilma Knol
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Adalsteinn Gudmundsson
- Landspitali University Hospital, Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gijsbertus Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands and Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Martin Wehling
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Denis O’Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland and Department of Medicine, University College Cork, Cork, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Leache Alegría L, Gutiérrez-Valencia M, Saiz LC, Erviti J. Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018. An Sist Sanit Navar 2021; 44:385-396. [PMID: 34165448 DOI: 10.23938/assn.0962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. METHODS An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchio-litis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. RESULTS Overall, 3.5?% (IQR: 3.4-3.5?%) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchi-tis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p?<?0.001) and increased by 65.7?% from 1997 to 2018. A 41.2?% of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchi-tis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p?<?0,001). In 89.1?% of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8?%, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7?%; p?<?0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). The 75.5?% of the deaths occurred amongst people over 74 years. CONCLUSIONS LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.
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Affiliation(s)
- L Leache Alegría
- Unit of Innovation and Organization. Navarre Health Service. Tudela street 20, 1st floor, Pamplona, Spain, Zip code: 31003.
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21
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Leache L, Saiz LC, Gutiérrez-Valencia M, Erviti J. [Orphan drugs, incentives and uncertainty about their risk-benefit balance]. Gac Sanit 2020; 35:208-209. [PMID: 32723521 DOI: 10.1016/j.gaceta.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España.
| | - Luis Carlos Saiz
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | | | - Juan Erviti
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
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Saiz LC, Erviti J, Leache L, Gutiérrez-Valencia M. Misreporting of a Plasma-Rich-in-Growth-Factors Trial on Knee Osteoarthritis. Arthroscopy 2020; 36:622-623. [PMID: 32139042 DOI: 10.1016/j.arthro.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
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Gutiérrez-Valencia M, Martínez-Velilla N. Frailty in the older person: Implications for pharmacists. Am J Health Syst Pharm 2019; 76:1980-1987. [PMID: 31622459 DOI: 10.1093/ajhp/zxz217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marta Gutiérrez-Valencia
- Pharmacy Department, Navarrabiomed, Universidad Pública de Navarra, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona Navarra, Spain
| | - Nicolás Martínez-Velilla
- Geriatric Department, Navarrabiomed, Universidad Pública de Navarra, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona Navarra, Spain, Biomedical Research Networking Center of Frailty and Healthy Aging, Madrid, Spain
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Redín-Sagredo MJ, Aldaz Herce P, Casas Herrero A, Gutiérrez-Valencia M, Martínez-Velilla N. [Heterogeneity amongst different diagnostic tools in frailty screening]. An Sist Sanit Navar 2019; 42:169-178. [PMID: 31322141 DOI: 10.23938/assn.0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. METHODS Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. RESULTS Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. CONCLUSION Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.
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Gutiérrez-Valencia M, Aldaz Herce P, Lacalle-Fabo E, Contreras Escámez B, Cedeno-Veloz B, Martínez-Velilla N. Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017. Med Clin (Barc) 2019; 153:141-150. [DOI: 10.1016/j.medcli.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
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Gutiérrez-Valencia M, Izquierdo M, Beobide-Telleria I, Ferro-Uriguen A, Alonso-Renedo J, Casas-Herrero Á, Martínez-Velilla N. Medicine optimization strategy in an acute geriatric unit: The pharmacist in the geriatric team. Geriatr Gerontol Int 2019; 19:530-536. [PMID: 30950148 DOI: 10.1111/ggi.13659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/28/2018] [Accepted: 02/20/2019] [Indexed: 01/18/2023]
Abstract
AIM Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness. METHODS The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated. RESULTS From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (-10.2%, 95% CI -15.3, -5.2), hyperpolypharmacy (-16.6%, 95% CI -22.3 -11.0), number of medications (-1.4, 95% CI -1.8, -1.0), Screening Tool of Older Person's Prescription criteria (-19.2%, 95% CI -24.9, -13.6), Screening Tool to Alert Doctors to Right Treatment criteria (-6.8%, 95% CI -10.1, -3.5) and drug-related problems (-2.7, 95% CI -2.9, -2.4; P ≤ 0.001 for all). CONCLUSIONS A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing. Geriatr Gerontol Int 2019; 19: 530-536.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Health Science Department, Public University of Navarra, Pamplona, Spain.,Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mikel Izquierdo
- Health Science Department, Public University of Navarra, Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain
| | | | | | - Javier Alonso-Renedo
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Álvaro Casas-Herrero
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Nicolás Martínez-Velilla
- Geriatrics Research Group, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Group CB16/10/00315, CIBER of Frailty and Healthy Aging, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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Seppala LJ, van der Velde N, Masud T, Blain H, Petrovic M, van der Cammen TJ, Szczerbińska K, Hartikainen S, Kenny RA, Ryg J, Eklund P, Topinková E, Mair A, Laflamme L, Thaler H, Bahat G, Gutiérrez-Valencia M, Caballero-Mora MA, Landi F, Emmelot-Vonk MH, Cherubini A, Baeyens JP, Correa-Pérez A, Gudmundsson A, Marengoni A, O'Mahony D, Parekh N, Pisa FE, Rajkumar C, Wehling M, Ziere G. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Eur Geriatr Med 2019; 10:275-283. [PMID: 34652762 DOI: 10.1007/s41999-019-00162-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.
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Affiliation(s)
- L J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Blain
- Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier University, Euromov, France
| | - M Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - T J van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - S Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - E Topinková
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - A Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | - L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177, Stockholm, Sweden
| | - H Thaler
- Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - G Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - M Gutiérrez-Valencia
- Department of Health Sciences, Public University of Navarra (UPNA), Avda, Barañain s/n, 31008, Pamplona, Spain
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital Universitario de Getafe and CIBER de Fragilidad y Envejecimiento Saludable, Getafe, Madrid, Spain
| | - F Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - M H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - A Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'Invecchiamento, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - J P Baeyens
- University of Luxembourg, Ezch-sur-Alzette, Luxembourg.,AZ Alma, Eeklo, Belgium
| | - A Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - A Gudmundsson
- Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - D O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - N Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK
| | - F E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - C Rajkumar
- Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - M Wehling
- Institute of Clinical Pharmacology Mannheim, University of Heidelberg, Heidelberg, Germany
| | - G Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Seppala LJ, van der Velde N, Masud T, Blain H, Petrovic M, van der Cammen TJ, Szczerbińska K, Hartikainen S, Kenny RA, Ryg J, Eklund P, Topinková E, Mair A, Laflamme L, Thaler H, Bahat G, Gutiérrez-Valencia M, Caballero-Mora MA, Landi F, Emmelot-Vonk MH, Cherubini A, Baeyens JP, Correa-Pérez A, Gudmundsson A, Marengoni A, O'Mahony D, Parekh N, Pisa FE, Rajkumar C, Wehling M, Ziere G. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging 2019; 36:299-307. [PMID: 30741371 PMCID: PMC6435622 DOI: 10.1007/s40266-018-0622-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.
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Affiliation(s)
- L J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Blain
- Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier University, Euromov, France
| | - M Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
| | - T J van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - S Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - E Topinková
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, Česke Budějovice, Czech Republic
| | - A Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | - L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177, Stockholm, Sweden
| | - H Thaler
- Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - G Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34093, Istanbul, Turkey
| | - M Gutiérrez-Valencia
- Department of Health Sciences, Public University of Navarra (UPNA), Avda, Barañain s/n, 31008, Pamplona, Spain
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital Universitario de Getafe and CIBER de Fragilidad y Envejecimiento Saludable, Getafe, Madrid, Spain
| | - F Landi
- Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - M H Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'Invecchiamento, Italian National Research Center on Aging (INRCA), Ancona, Italy
| | - J P Baeyens
- University of Luxembourg, Ezch-sur-Alzette, Luxembourg
- AZ Alma, Eeklo, Belgium
| | - A Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - A Gudmundsson
- Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - D O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - N Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, Sussex, UK
| | - F E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - C Rajkumar
- Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Sussex, UK
| | - M Wehling
- Institute of Clinical Pharmacology Mannheim, University of Heidelberg, Heidelberg, Germany
| | - G Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Gutiérrez-Valencia M, Martínez-Velilla N. [Only «potentially» inappropriate]. Rev Esp Geriatr Gerontol 2019; 54:62. [PMID: 30389196 DOI: 10.1016/j.regg.2018.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Marta Gutiérrez-Valencia
- Servicio de Farmacia, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, España.
| | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, España
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30
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Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Sáez de Asteasu ML, Lucia A, Galbete A, García-Baztán A, Alonso-Renedo J, González-Glaría B, Gonzalo-Lázaro M, Apezteguía Iráizoz I, Gutiérrez-Valencia M, Rodríguez-Mañas L, Izquierdo M. Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med 2019; 179:28-36. [PMID: 30419096 PMCID: PMC6583412 DOI: 10.1001/jamainternmed.2018.4869] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. OBJECTIVE To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. DESIGN, SETTING, AND PARTICIPANTS A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. INTERVENTIONS The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). MAIN OUTCOMES AND MEASURES The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. RESULTS Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points (95% CI, -6.8 to -3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, -0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. CONCLUSIONS AND RELEVANCE The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02300896.
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Affiliation(s)
- Nicolás Martínez-Velilla
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Alvaro Casas-Herrero
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Mikel L Sáez de Asteasu
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Alejandro Lucia
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain.,Research Institute of the Hospital 12 de Octubre ("i+12"), Madrid, Spain
| | - Arkaitz Galbete
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Agurne García-Baztán
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Javier Alonso-Renedo
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Belen González-Glaría
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - María Gonzalo-Lázaro
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Itziar Apezteguía Iráizoz
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Marta Gutiérrez-Valencia
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Mikel Izquierdo
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed) and Navarra Institute for Health Research, Pamplona, Navarra, Spain.,Biomedical Research Networking Centers of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.,Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain
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Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, Denkinger M, Gutiérrez-Valencia M, Guðmundsson A, Knol W, Mak DV, O'Mahony D, Pazan F, Petrovic M, Rajkumar C, Topinkova E, Trevisan C, van der Cammen TJM, van Marum RJ, Wehling M, Ziere G, Bernabei R, Onder G. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med 2018; 10:9-36. [PMID: 32720270 DOI: 10.1007/s41999-018-0124-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER CRD42018104756.
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Affiliation(s)
- Katie Palmer
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venezia, Italia.
| | - Emanuele R Villani
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.,Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Denis Curtin
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany
| | - Marta Gutiérrez-Valencia
- Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, Spain
| | - Adalsteinn Guðmundsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland
| | - Wilma Knol
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diane V Mak
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Farhad Pazan
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
| | - Chakravarthi Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Catarina Trevisan
- Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy
| | - Tischa J M van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | - Rob J van Marum
- Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Martin Wehling
- Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany
| | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Gutiérrez-Valencia M, Izquierdo M, Lacalle-Fabo E, Marín-Epelde I, Ramón-Espinoza MF, Domene-Domene T, Casas-Herrero Á, Galbete A, Martínez-Velilla N. Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes. Eur J Clin Pharmacol 2018; 74:961-970. [PMID: 29589065 DOI: 10.1007/s00228-018-2452-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/19/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Frailty, polypharmacy, and underprescription are considered a major matter of concern in nursing homes, but the possible relationships between them are not well known. The aim is to examine the possible association between medication underprescription, polypharmacy, and frailty in older people living in nursing homes. METHODS A cross-sectional analysis from a concurrent cohort study, including 110 subjects ≥ 65 years living in two nursing homes. Four frailty scales were applied; polypharmacy was defined as ≥ 5 medications and underprescription was measured with Screening Tool to Alert to Right Treatment (START) criteria. Logistic regression models were performed to assess the associations. RESULTS The mean age was 86.3 years (SD 7.3) and 71.8% were female. 73.6% of subjects took ≥ 5 chronic medications and 60.9% met one or more START criteria. The non-frail participants took more medications than the frail subjects according to the imputated frailty Fried criteria (8.1 vs 6.7, p = 0.042) and the FRAIL-NH scale (7.8 vs 6.8, p = 0.026). Multivariate analyses did not find an association between frailty and polypharmacy. Frail participants according to the Fried criteria met a higher number of START criteria (1.9 vs 1.0, p = 0.017), and had a higher prevalence of underprescription (87.5 vs 50.0%), reaching the limit of statistical significance in multivariate analysis. CONCLUSION The positive association found in previous studies between frailty and polypharmacy cannot be extrapolated to institutionalized populations. There is a trend towards higher rates of underprescription in frail subjects. Underprescription in frail older adults should be redefined and new strategies to measure it should be developed.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain.
- IdiSNa, Navarra Institute for Health Research, Pamplona, Navarra, Spain.
| | - Mikel Izquierdo
- Health Science Department, Public University of Navarra, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging, Madrid, Spain
| | - Esther Lacalle-Fabo
- Pharmacy Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Itxaso Marín-Epelde
- Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain
| | | | - Thamara Domene-Domene
- Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Álvaro Casas-Herrero
- Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNa, Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Arkaitz Galbete
- Navarrabiomed-Departamento de Salud-UPNA, Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Nicolás Martínez-Velilla
- Department of Geriatrics, Complejo Hospitalario de Navarra, C/Irunlarrea 3, 31008, Pamplona, Spain
- IdiSNa, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging, Madrid, Spain
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Gutiérrez-Valencia M, Martínez-Velilla N. [Pharmacological prevention of delirium: A long way to go]. Rev Esp Geriatr Gerontol 2018; 53:185-187. [PMID: 29598970 DOI: 10.1016/j.regg.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Affiliation(s)
| | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; IdiSNa, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, España; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España
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Gutiérrez-Valencia M, Martínez-Velilla N. Applicability of fixed-dose combination therapy in complex patients. Med Clin (Barc) 2017; 149:367. [PMID: 28476450 DOI: 10.1016/j.medcli.2017.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Marta Gutiérrez-Valencia
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España.
| | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
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Gutiérrez-Valencia M, Martínez-Velilla N, Vetrano DL, Corsonello A, Lattanzio F, Ladrón-Arana S, Onder G. Anticholinergic burden and health outcomes among older adults discharged from hospital: results from the CRIME study. Eur J Clin Pharmacol 2017; 73:1467-1474. [DOI: 10.1007/s00228-017-2312-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
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Martínez-Velilla N, Herce PA, Herrero ÁC, Gutiérrez-Valencia M, Sáez de Asteasu ML, Mateos AS, Zubillaga AC, Beroiz BI, Jiménez AG, Izquierdo M. Heterogeneity of Different Tools for Detecting the Prevalence of Frailty in Nursing Homes: Feasibility and Meaning of Different Approaches. J Am Med Dir Assoc 2017; 18:898.e1-898.e8. [PMID: 28757333 DOI: 10.1016/j.jamda.2017.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis from a concurrent cohort study, which included 110 participants aged over 65 years and with different degrees of disability at 2 nursing homes. MEASUREMENTS The study used 4 different frailty scales: The Fried frailty criteria, the imputed Fried frailty criteria, the Rockwood clinical frailty scale, and the frailty in nursing home scale, and we analyzed their relationship with disability and multimorbidity. RESULTS The mean age of the study population was 86.3 years (standard deviation 7.3), and 71.8% were female. Most residents had a high percentage of cognitive and functional impairment, multimorbidity, and risk of malnutrition. The following prevalence rates for frailty were determined: 71.8% (62.8, 79.4), 42.7% (33.9, 52.1), and 36.4% (23.8, 51.1) as per according to the Rockwood clinical frailty scale, frailty in nursing home scale, and Fried index (95% confidence interval), respectively. In the case of the Fried index, the prevalence of frailty is based on the percentage of patients meeting the criteria, which is 40% due to the large number of missing values. After the imputation of variables with the multivariate imputation by chained equation software, the prevalence of frailty increased to 66.4% (57.1, 74.5). We observed different statistically significant associations between the frailty scales and the clinical and demographic variables, and also with disability and multimorbidity. CONCLUSIONS Most residents of nursing homes are likely to be frail, but there is no single operational definition of frailty. Although all measures of frailty had similar associations with the clinical variables of the study, there are important conceptual differences that must be considered in addressing the relationships between frailty, disability, and multimorbidity. Further research is required, and homogeneous frailty criteria must be used so that studies and interventions can be compared.
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Affiliation(s)
- N Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain.
| | | | - Álvaro Casas Herrero
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain
| | - Marta Gutiérrez-Valencia
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España
| | | | | | | | - Berta Ibáñez Beroiz
- Navarrabiomed-Departamento de Salud-Universidad Pública de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Arkaitz Galbete Jiménez
- Navarrabiomed-Departamento de Salud-Universidad Pública de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Mikel Izquierdo
- Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain; Department of Health Sciences, Public University of Navarre, Pamplona, Spain
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Gutiérrez-Valencia M, Martínez-Velilla N. [Deprescription, what are we talking about?]. Farm Hosp 2017; 41:567-568. [PMID: 28683712 DOI: 10.7399/fh.2017.41.4.10768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Marta Gutiérrez-Valencia
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra..
| | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra..
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Gutiérrez-Valencia M, Larrayoz-Sola B, Monforte-Gasque MP, Martínez-Velilla N. [Complementary approaches in the elderly on multiple medications: A look at the most vulnerable sectors]. Rev Esp Geriatr Gerontol 2017; 52:174-175. [PMID: 27979660 DOI: 10.1016/j.regg.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Marta Gutiérrez-Valencia
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España.
| | | | | | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España
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Gutiérrez-Valencia M, Izquierdo M, Malafarina V, Alonso-Renedo J, González-Glaría B, Larrayoz-Sola B, Monforte-Gasque MP, Latasa-Zamalloa P, Martínez-Velilla N. Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: A retrospective study. Geriatr Gerontol Int 2017; 17:2354-2360. [PMID: 28422415 DOI: 10.1111/ggi.13073] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/24/2017] [Accepted: 03/07/2017] [Indexed: 12/25/2022]
Abstract
AIM Polypharmacy is a highly prevalent geriatric syndrome, and hospitalizations can worsen it. The aim of the present study was to analyze the influence of hospitalization on polypharmacy and indicators of quality of prescribing, and their possible association with health outcomes. METHODS A retrospective study of 200 patients discharged from an acute geriatric unit was carried out. Indicators of quality of prescription were registered at admission and discharge: polypharmacy defined as ≥5 medications, hyperpolypharmacy (≥10), potentially inappropriate prescribing by Beers and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, potentially prescribing omissions by Screening Tool to Alert doctors to the Right Treatment (START) criteria, drug interactions and anticholinergic burden measured with the Anticholinergic Risk Scale. Mortality, emergency room visits and hospital admissions occurring during 6 months after discharge were also registered. RESULTS The total number of drugs increased at discharge (9.1 vs 10.1, P < 0.001), without increasing chronic medications (8.5 vs 8.3, P = 0.699). No significant variations were observed in the prevalence of polypharmacy (86.5% vs 82.2%), potentially inappropriate prescribing (68.5% vs 71.5%), potential prescribing omissions (58% vs 58%) or drug interactions (82.5% vs 83.5%). Patients with anticholinergic drugs tended to increase, not reaching statistical significance (39.5% vs 44.5%; P = 0.064). Polypharmacy was associated with emergency room visits (OR 2.62, 95% CI 1.07-6.40; P = 0.034), and hyperpolypharmacy with hospitalizations (OR 2.49, 95% CI 1.25-4.93; P = 0.009). CONCLUSIONS After hospitalization in an acute geriatric unit, the prevalence of polypharmacy, potentially inappropriate prescribing, potential prescribing omissions, interactions or anticholinergic drugs is still very high. Polypharmacy is a risk factor for hospitalization and emergency room visits. Measuring indicators of quality of prescription might be useful to design interventions to optimize pharmacotherapy and improve health outcomes in elderly acute patients. Geriatr Gerontol Int 2017; 17: 2354-2361.
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Affiliation(s)
- Marta Gutiérrez-Valencia
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Mikel Izquierdo
- Health Science Department, Public University of Navarra, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging, Madrid, Spain
| | - Vincenzo Malafarina
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Department of Nutrition, Food Science and Physiology, School of Pharmacy, University of Navarra, Pamplona, Navarra, Spain
| | - Javier Alonso-Renedo
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Belén González-Glaría
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | | | | | - Pello Latasa-Zamalloa
- Subdivision of Epidemology, General Division of Public Health, Health Department of the Community of Madrid, Madrid, Spain
| | - Nicolás Martínez-Velilla
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,Navarra Institute for Health Research, Pamplona, Navarra, Spain.,CIBER of Frailty and Healthy Aging, Madrid, Spain
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