Terapijski problemi pacijenata sa kardiovaskularnim bolestima na prijemu u bolnicu

In patients with cardiovascular diseases drug-related problems (DRPs) can be associated with hospitalization or rehospitalization. The aim of the research was to analyse DRPs in the cardiology department on admission to the hospital. All patient records on admission to the cardiology department of the Clinical Hospital Center Zvezdara during 2018., were analyzed. Demographic and treatment data of the patient before admission to the hospital were collected. DRPs associated with pre-hospital treatment were identified and classified according to the PCNE (Pharmaceutical Care Network Europe, version 9.1) classification. DRPs were also evaluated as cause of the patient's hospitalization. Data were analyzed descriptively and with linear regression analysis. During the research period, 143 patients were admitted to the cardiology department, with an average age of 69.75 ± 10.11 years, of which 65.7% were male. Patients had an average of 4.36±2.13 diagnoses and 5.24±3.39 medications on admission. We observed 1.85±1.37 DRPs per patient (range 0-5). The most common DRP (75.6%) was lack of ≥1 drugs in the therapy preceding the admission, most often statins (30.1% of patients), beta-blockers (25.9%), angiotensin- converting enzyme inhibitors (17.5%) and antiarrhythmics/anticoagulants (12.6%). In 96 patients (67.1%) the identified DRPs could be associated with the cause of hospitalization. Atrial fibrillation was the predictor of the number of DRPs in patients (p <0.001). In most cardiovascular patients, the cause of hospitalization could be associated with DRPs before admission. Incomplete therapy of the patient was commonly observed, the cause of which may be inadequate prescribing or lack of adherence of the patient.Pacijenti sa kardiovaskularnim bolestima susreću se sa brojnim problemima u terapiji od kojih pojedini mogu biti uzrok hospitalizacije ili rehospitalizacije. Cilj istraživanja je bio da se prikaže analiza terapijskih problema pacijenata na odeljenju kardiologije, prilikom prijema u bolnicu. Analizirani su kartoni svih pacijenata primljenih na odeljenje kardiologije, Kliničko-bolničkog centra Zvezdara tokom 2018. godine. Prikupljeni su demografski i podaci o celokupnoj terapiji pacijenta pre prijema u bolnicu. Identifikovani su problemi u vezi sa terapijom pre prijema u bolnicu i klasifikovani su prema PCNE (Pharmaceutical Care Network Europe, verzija 9.1) klasifikaciji. Takođe, procenjeno je da li problemi u vezi sa terapijom mogu biti uzrok hospitalizacije pacijenta. Podaci su analizirani deskriptivno i primenom linearne regresione analize. U periodu istraživanja 143 pacijenta je primljeno na odeljenje kardiologije, prosečne starosti 69,75±10,11 godina, od kojih je 65,7% bilo muškog pola. Pacijenti su u proseku imali 4,36±2,13 dijagnoze i 5,24±3,39 lekova na prijemu. Utvrđeno je prisustvo 1,85±1,37 terapijskih problema po pacijentu (opseg 0-5). Najčešći terapijski problem (75,6%) bio je nedostatak ≥1 leka u terapiji i to najčešće statina (30,1% pacijenata), beta-blokatora (25,9%), inhibitora angiotenzin-konvertujućeg enzima (17,5%) i antiaritmika/anitkoagulanasa (12,6%). Kod 96 pacijenata (67,1%) su identifikovani terapijski problemi dovedeni u vezu sa uzrokom hospitalizacije. Prediktivni faktor za broj terapijskih problema kod pacijenata je bilo prisustvo atrijalne fibrilacije u anamnezi (p<0,001). Uzrok hospitalizacije pacijenata sa kardiovaskularnim bolestima se često može povezati sa problemima u terapiji pre prijema. Najčešće se uočava nepotpuna terapija pacijenta čiji uzrok može biti neodgovarajuće propisivanje ili nedostatak adherence pacijenta.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Pregled klinički značajnih interakcija u terapiji kardiovaskularnih bolesti kod pacijenata na prijemu u bolnicu

Clinically significant drug-drug interactions (DDIs) are expected in patients with cardiovascular diseases due to the number of drugs in therapy. The aim of the research was to analyze DDIs during treatment which preceeded the admission to the cardiology department. In the cardiology department of the Clinical Hospital Center Zvezdara, the treatment of patients with ≥2 drugs before admission was analyzed. DDIs were identified using the Lexicomp database (Lexi-Interact). Data were analyzed descriptively and with linear regression analysis. During research, out of 132 participants 88.6% had ≥1, while 41.7% had ≥5 DDIs. The total number of DDIs was 648 (median 3, range 0-19). Men constituted 64.4% of the population, with a median age of 70 years (32-90). Patients had 4 diagnoses (1-13) and 6 medications on admission (2-15). In 3.8% of patients, contraindicated DDIs of anticholinergics were observed, 23.5% had DDIs that required caution or a change in therapy, while interactions requiring follow-up were observed in 86.4% of patients. Angiotensin-converting enzyme inhibitors (30.4%), acetylsalicylic acid (26.6%) and loop diuretics (16.5%) were most frequently involved in DDIs, while the most common adverse events could be renal failure (21.5%), hypotension 19.7%) and bleeding (13.7%). The number of drugs in therapy was a predictor of DDIs (p <0.001). Patients with cardiovascular disease are often exposed to polypharmacy and consequently DDIs. Cardiovascular drugs were most frequently involved in DDIs, but contraindicated DDIs were present in anticholinergic drugs. In patients with cardiovascular diseases, monitoring of renal function, hypotension and bleeding is required.Klinički značajne interakcije (KZI) očekuju se kod pacijenata sa kardiovaskularnim bolestima usled većeg broja lekova u terapiji. Cilj istraživanja je bio da se identifikuju i analiziraju KZI pacijenata koje su prethodile prijemu na odeljenje kardiologije. U Kliničko- bolničkom centru Zvezdara, na odeljenju kardiologije, analizirana je terapija pacijenata sa ≥2 leka pre prijema. KZI su identifikovane upotrebom baze Lexicomp (Lexi-Interact). Podaci su analizirani deskriptivno i primenom linearne regresione analize. Od 132 učesnika u istraživanju 88,6% je imalo ≥1, dok je 41,7% imalo ≥5 KZI. Ukupan broj KZI bio je 648 (medijana 3, opseg 0-19). U populaciji je bilo 64,4% muškaraca medijane starosti 70 godina (32-90). Pacijenti su imali 4 dijagnoze (1-13) i 6 lekova na prijemu (2-15). Kod 3,8% pacijenata utvrđene su KZI antiholinergika koje se smatraju kontraindikovanim. Približno jedna četvrtina pacijenata (23,5%) je imala KZI koja zahteva oprez ili izmenu u terapiji dok su kod 86,4% pacijenata uočene interakcije koje zahtevaju praćenje ishoda. Najčešće su u KZI stupali inhibitori angiotenzin-konvertujućeg enzima (30,4%), acetilsalicilna kiselina (26,6%) i diuretici petlje (16,5%) dok su najčešći neželjeni ishodi mogli biti bubrežna insuficijencija (21,5%), hipotenzija (19,7%) i krvarenje (13,7%). Broj lekova u terapiji bio je prediktor za KZI (p<0,001). Pacijenti sa kardiovaskularnim bolestima su često izloženi polifarmaciji i posledično većem broju KZI. U KZI su najčešće stupali lekovi u terapiji kardiovaskularnih bolesti ali su kontraindikovane KZI bile zastupljene kod antiholinergičkih lekova. Kod pacijenata sa kardiovaskularnim bolestima potrebno je praćenje renalne funkcije, hipotenzije i krvarenja.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Drug-Related Problems Prior to Hospitalization on Internal Medicine Wards

Drug-related hospitalizations pose a significant burden to the health-care system. The aim was to investigate the prevalence of drug-related problems (DRPs) and their association with hospital admissions in five internal medicine wards. The study included patients admitted to the nephrology, cardiology, gastroenterology, endocrinology, and geriatric wards. The Pharmaceutical Care Network Europe classification V9.1 was used for identifying DRPs. In total, 535 patients participated in the study. We identified 954 DRPs (range 1-7) in 80.7% of patients. Most DRPs were identified on the endocrinology, cardiology, and geriatric wards, and they were associated with the efficacy of treatment (71.4%), adverse drug events (10.2%), and unnecessary drug treatment (18.4%). DRPs were associated with the cause of hospitalization in 74.4% of patients on the nephrology ward, 60.1% and 60.6% of patients on the cardiology and endocrinology wards, respectively, whereas this number was lower on the geriatric and gastroenterology wards (26.9% and 8.9%, respectively). Suboptimal drug treatment due to medication omissions was often associated with the potential cause of hospital admission. Focusing on patients with specific diseases and DRPs, rather than reducing the number of medications in primary care, may be potentially rational in an attempt to reduce drug-related hospitalizations