만성 심부전 노인 환자에서 다약제 사용에 따른 위험성 평가 (Risk Assessment of Polypharmacy in Elderly Patients with Chronic Heart Failure)

서지정보

· 발행기관 : 한국병원약사회
· 수록지 정보 : 병원약사회지 / 38권 / 1호 / 30 ~ 40페이지
· 저자명 : 구현준, 권은영

초록

Background and objective : Elderly patients with chronic heart failure have polypharmacy to control chronic heart failure and comorbidities. Polypharmacy may increase the use of inappropriate medications and the risk of adverse drug reactions (ADRs). The purpose of this study was to evaluate the causality between polypharmacy and ADRs in elderly patients with chronic heart failure.
Methods : This study included chronic heart failure outpatients aged 65 and older who visited our facility from January 1 to June 30, 2018. The total number of medications, potentially inappropriate medications (PIMs), and suspected ADRs were analyzed. An analysis was conducted to determine which factors influenced the occurrence of suspected ADR.
Results : The mean age of the 286 patients with one or more comorbidities was 78.6 years (SD 7.2), and 64.3% were female. There were 76 patients in the group taking 1 – 4 medications, 152 in the group taking 5 – 9 medications, and 58 patients in the group taking 10 or more. There were 149 patients in the group not taking PIM, 86 in the group taking one PIM, and 51 in the group taking two or more. There were 129 suspected ADR cases. The number of medications was the factor influencing suspected ADRs. The odds ratio of suspected ADRs was 3.87 in the 5 – 9 medications group (95% CI: 1.79 – 8.38, p=0.0006) and 6.48 in the 10 or more group (95% CI: 2.73 –15.41, p< 0.0001) compared to the 1 – 4 medications group.
Conclusion : In outpatients 65 years or older with chronic heart failure, polypharmacy increased the risk of suspected ADRs. Medication reconciliation by the pharmacist focused on polypharmacy and PIM will reduce ADRs, and lead to safe and appropriate drug therapy.

영어초록

Background and objective : Elderly patients with chronic heart failure have polypharmacy to control chronic heart failure and comorbidities. Polypharmacy may increase the use of inappropriate medications and the risk of adverse drug reactions (ADRs). The purpose of this study was to evaluate the causality between polypharmacy and ADRs in elderly patients with chronic heart failure.
Methods : This study included chronic heart failure outpatients aged 65 and older who visited our facility from January 1 to June 30, 2018. The total number of medications, potentially inappropriate medications (PIMs), and suspected ADRs were analyzed. An analysis was conducted to determine which factors influenced the occurrence of suspected ADR.
Results : The mean age of the 286 patients with one or more comorbidities was 78.6 years (SD 7.2), and 64.3% were female. There were 76 patients in the group taking 1 – 4 medications, 152 in the group taking 5 – 9 medications, and 58 patients in the group taking 10 or more. There were 149 patients in the group not taking PIM, 86 in the group taking one PIM, and 51 in the group taking two or more. There were 129 suspected ADR cases. The number of medications was the factor influencing suspected ADRs. The odds ratio of suspected ADRs was 3.87 in the 5 – 9 medications group (95% CI: 1.79 – 8.38, p=0.0006) and 6.48 in the 10 or more group (95% CI: 2.73 –15.41, p< 0.0001) compared to the 1 – 4 medications group.
Conclusion : In outpatients 65 years or older with chronic heart failure, polypharmacy increased the risk of suspected ADRs. Medication reconciliation by the pharmacist focused on polypharmacy and PIM will reduce ADRs, and lead to safe and appropriate drug therapy.

참고자료

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