19 research outputs found
Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia
Get PDFPrognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients
No full textStudy objective: This study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge.
Methods: A prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0-11.9g/dL in women; 10.0-12.9g/dL in men) and group 3 with moderately-severely reduced Hb (<10g/dL in women and men).
Results: Patients (2678; mean age 79.2±7.4y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR=1.62; 95%CI 1.21-2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR=1.82;95%CI 1.25-2.67; group 3: OR=2.78;95%CI 1.82-4.26) and discharge (group 2: OR=2.37;95%CI 1.48-3.93; group 3: OR=3.70;95%CI 2.14-6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes.
Conclusions: Mild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia
Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study
No full textBackground: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up
Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study
No full text333noneBackground: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0 %) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9 % of patients were on guideline-adherent thromboprophylaxis, 6.8 % were overtreated, and 52.3 % were undertreated. Logistic analysis showed that increasing age (p = 0.01), heart failure (p = 0.04), coronary artery disease (p = 0.013), peripheral arterial disease (p = 0.03) and concomitant cancer (p = 0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p = 0.001) and cancer (p < 0.001), and inversely associated with HF (p = 0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p = 0.007) and CV death (p = 0.024) compared to those non-adherent. Kaplan–Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p = 0.002) and CV deaths (p = 0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p = 0.019 and p = 0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.Proietti, M.;
Nobili, A.;
Raparelli, V.;
Napoleone, L.;
Mannucci, P.M.;
Lip, G.Y.H.;
Pasina, L.;
Franchi, C.;
Tettamanti, M.;
Eldin, T.K.;
Di Blanca, M.P.D.;
Djade, C.D.;
Ardoino, I.;
Cortesi, L.;
Marengoni, A.;
Licata, G.;
Violi, F.;
Corazza, G.R.;
Biolo, G.;
Guarnieri, G.;
Zanetti, M.;
Fernandes, G.;
Vanoli, M.;
Grignani, G.;
Casella, G.;
Bernardi, M.;
Bassi, S.L.;
Santi, L.;
Zaccherini, G.;
Mannarino, E.;
Lupattelli, G.;
Bianconi, V.;
Paciullo, F.;
Nuti, R.;
Valenti, R.;
Ruvio, M.;
Cappelli, S.;
Palazzuoli, A.;
Salvatore, T.;
Sasso, F.C.;
Girelli, D.;
Olivieri, O.;
Matteazzi, T.;
Barbagallo, M.;
Plances, L.;
Alcamo, R.;
Licata, G.;
Calvo, L.;
Valenti, M.;
Zoli, M.;
Arnò, R.;
Pasini, F.L.;
Capecchi, P.L.;
Bicchi, M.;
Palasciano, G.;
Modeo, M.E.;
Peragine, M.;
Pappagallo, F.;
Di Gennaro, C.;
Postiglione, A.;
Barbella, M.R.;
De Stefano, F.;
Cappellini, M.D.;
Fabio, G.;
Seghezzi, S.;
De Amicis, M.M.;
Mari, D.;
Rossi, P.D.;
Ottolini, B.B.;
Miceli, E.;
Lenti, M.V.;
Padula, D.;
Murialdo, G.;
Marra, A.;
Cattaneo, F.;
Secchi, M.B.;
Ghelfi, D.;
Anastasio, L.;
Sofia, L.;
Carbone, M.;
Damanti, S.;
Guagnano, M.T.;
Sestili, S.;
Mancuso, G.;
Calipari, D.;
Bartone, M.;
Meroni, M.R.;
Perin, P.C.;
Lorenzati, B.;
Gruden, G.;
Bruno, G.;
Amione, C.;
Fornengo, P.;
Tassara, R.;
Melis, D.;
Rebella, L.;
Pretti, V.;
Masala, M.S.;
Bolondi, L.;
Rasciti, L.;
Serio, I.;
Fanelli, F.R.;
Amoroso, A.;
Molfino, A.;
Petrillo, E.;
Zuccalà, G.;
Franceschi, F.;
De Marco, G.;
Chiara, C.;
Marta, S.;
Romanelli, G.;
Amolini, C.;
Chiesa, D.;
Picardi, A.;
Gentilucci, U.V.;
Gallo, P.;
Annoni, G.;
Corsi, M.;
Zazzetta, S.;
Bellelli, G.;
Arturi, F.;
Succurro, E.;
Rubino, M.;
Sesti, G.;
Loria, P.;
Becchi, M.A.;
Martucci, G.;
Fantuzzi, A.;
Maurantonio, M.;
Carta, S.;
Atzori, S.;
Serra, M.G.;
Bleve, M.A.;
Gasbarrone, L.;
Sajeva, M.R.;
Brucato, A.;
Ghidoni, S.;
Di Corato, P.;
Agnelli, G.;
Marchesini, E.;
Fabris, F.;
Carlon, M.;
Baritusso, A.;
Manfredini, R.;
Molino, C.;
Pala, M.;
Fabbian, F.;
Boari, B.;
De Giorgi, A.;
Paolisso, G.;
Rizzo, M.R.;
Laieta, M.T.;
Rini, G.;
Mansueto, P.;
Pepe, I.;
Borghi, C.;
Strocchi, E.;
De Sando, V.;
Sabbà, C.;
Vella, F.S.;
Turatto, F.;
Valerio, R.bg,
Capobianco, C.;
Fenoglio, L.;
Bracco, C.;
Giraudo, A.V.;
Testa, E.;
Serraino, C.;
Fargion, S.;
Bonara, P.;
Periti, G.;
Porzio, M.;
Peyvandi, F.;
Tedeschi, A.;
Rossio, R.;
Monzani, V.;
Savojardo, V.;
Folli, C.;
Magnini, M.;
Gobbo, G.;
Balduini, C.L.;
Bertolino, G.;
Provini, S.;
Quaglia, F.;
Dallegri, F.;
Ottonello, L.;
Liberale, L.;
Chin, W.S.;
Carassale, L.;
Caporotundo, S.;
Traisci, G.;
De Feudis, L.;
Di Carlo, S.;
Liberato, N.L.;
Buratti, A.;
Tognin, T.;
Bianchi, G.B.;
Giaquinto, S.;
Purrello, F.;
Di Pino, A.;
Piro, S.;
Conca, A.;
Falanga, L.;
Montrucchio, G.;
Greco, E.;
Tizzani, P.;
Petitti, P.;
Perciccante, A.;
Coralli, A.;
Salmi, R.;
Gaudenzi, P.;
Gamberini, S.;
Semplicini, A.;
Gottardo, L.;
Vendemiale, G.;
Serviddio, G.;
Forlano, R.;
Masala, C.;
Mammarella, A.;
Basili, S.;
Perri, L.;
Landolfi, R.;
Montalto, M.;
Mirijello, A.;
Vallone, C.;
Bellusci, M.;
Setti, D.;
Pedrazzoli, F.;
Guasti, L.;
Castiglioni, L.;
Maresca, A.;
Squizzato, A.;
Molaro, M.;
Bertolotti, M.ce,
Mussi, C.;
Libbra, M.V.;
Miceli, A.;
Pellegrini, E.;
Carulli, L.;
Sciacqua, A.;
Quero, M.;
Bagnato, C.;
Corinaldesi, R.;
De Giorgio, R.;
Serra, M.;
Grasso, V.;
Ruggeri, E.;
Salvi, A.;
Leonardi, R.;
Grassini, C.;
Mascherona, I.;
Minelli, G.;
Maltese, F.;
Gabrielli, A.;
Mattioli, M.;
Capeci, W.;
Martino, G.P.;
Messina, S.;
Ghio, R.;
Favorini, S.;
Col, A.D.;
Minisola, S.;
Colangelo, L.;
Afeltra, A.;
Alemanno, P.;
Marigliano, B.;
Castellino, P.;
Blanco, J.;
Zanoli, L.;
Cattaneo, M.;
Fracasso, P.;
Amoruso, M.V.;
Saracco, V.;
Fogliati, M.;
Bussolino, C.;
Durante, V.;
Eusebi, G.;
Tirotta, D.;
Mete, F.;
Gino, M.;
Cittadini, A.;
Arcopinto, M.;
Salzano, A.;
Bobbio, E.;
Marra, A.M.;
Sirico, D.;
Moreo, G.;
Scopelliti, F.;
Gasparini, F.;
Cocca, M.;
Nieves, R.D.;
Alberto, M.M.;
Pedro, A.R.;
Vanessa, L.P.;
Lara, T.;
Xavier, C.V.;
Francesc, F.;
Jesus, D.M.;
Esperanza, B.T.;
Behamonte Esther, D.C.;
Maria, S.P.;
Romero, M.;
Blanca, P.L.;
Cristina, L.G.-C.;
Victoria, V.G.M.;
Saez, L.;
Bosco, J.;
Susana, S.B.;
Marta, A.G.;
Concepcion, G.B.;
Antonio, F.M.;
Hernandez, M.G.;
Borrego, M.P.;
Raquel, P.C.;
Florencia, P.R.;
Beatriz, G.O.;
Sara, C.G.;
Cervellera Alfonso, G.-C.;
Marta, P.M.;
Alberto, R.C.;
Antonio, A.A.;
Montserrat, G.G.;
Miguel Ángel, B.R.;
Manuel, M.J.;
Ignacio, N.V.;
Lucía, A.S.;
Alfonso, L.;
David, R.B.;
Iria, I.V.;
Monica, R.P.;
On behalf of REPOSI investigatorsProietti, M.; Nobili, A.; Raparelli, V.; Napoleone, L.; Mannucci, P. M.; Lip, G. Y. H.; Pasina, L.; Franchi, C.; Tettamanti, M.; Eldin, T. K.; Di Blanca, M. P. D.; Djade, C. D.; Ardoino, I.; Cortesi, L.; Marengoni, A.; Licata, G.; Violi, F.; Corazza, G. R.; Biolo, G.; Guarnieri, G.; Zanetti, M.; Fernandes, G.; Vanoli, M.; Grignani, G.; Casella, G.; Bernardi, M.; Bassi, S. L.; Santi, L.; Zaccherini, G.; Mannarino, E.; Lupattelli, G.; Bianconi, V.; Paciullo, F.; Nuti, R.; Valenti, R.; Ruvio, M.; Cappelli, S.; Palazzuoli, A.; Salvatore, T.; Sasso, F. C.; Girelli, D.; Olivieri, O.; Matteazzi, T.; Barbagallo, M.; Plances, L.; Alcamo, R.; Licata, G.; Calvo, L.; Valenti, M.; Zoli, M.; Arnò, R.; Pasini, F. L.; Capecchi, P. L.; Bicchi, M.; Palasciano, G.; Modeo, M. E.; Peragine, M.; Pappagallo, F.; Di Gennaro, C.; Postiglione, A.; Barbella, M. R.; De Stefano, F.; Cappellini, M. D.; Fabio, G.; Seghezzi, S.; De Amicis, M. M.; Mari, D.; Rossi, P. D.; Ottolini, B. B.; Miceli, E.; Lenti, M. V.; Padula, D.; Murialdo, G.; Marra, A.; Cattaneo, F.; Secchi, M. B.; Ghelfi, D.; Anastasio, L.; Sofia, L.; Carbone, M.; Damanti, S.; Guagnano, M. T.; Sestili, S.; Mancuso, G.; Calipari, D.; Bartone, M.; Meroni, M. R.; Perin, P. C.; Lorenzati, B.; Gruden, G.; Bruno, G.; Amione, C.; Fornengo, P.; Tassara, R.; Melis, D.; Rebella, L.; Pretti, V.; Masala, M. S.; Bolondi, L.; Rasciti, L.; Serio, I.; Fanelli, F. R.; Amoroso, A.; Molfino, A.; Petrillo, E.; Zuccalà, G.; Franceschi, F.; De Marco, G.; Chiara, C.; Marta, S.; Romanelli, G.; Amolini, C.; Chiesa, D.; Picardi, A.; Gentilucci, U. V.; Gallo, P.; Annoni, G.; Corsi, M.; Zazzetta, S.; Bellelli, G.; Arturi, F.; Succurro, E.; Rubino, M.; Sesti, G.; Loria, P.; Becchi, M. A.; Martucci, G.; Fantuzzi, A.; Maurantonio, M.; Carta, S.; Atzori, S.; Serra, M. G.; Bleve, M. A.; Gasbarrone, L.; Sajeva, M. R.; Brucato, A.; Ghidoni, S.; Di Corato, P.; Agnelli, G.; Marchesini, E.; Fabris, F.; Carlon, M.; Baritusso, A.; Manfredini, R.; Molino, C.; Pala, M.; Fabbian, F.; Boari, B.; De Giorgi, A.; Paolisso, G.; Rizzo, M. R.; Laieta, M. T.; Rini, G.; Mansueto, P.; Pepe, I.; Borghi, C.; Strocchi, E.; De Sando, V.; Sabbà, C.; Vella, F. S.; Turatto, F.; Valerio, ; R., Bg; Capobianco, C.; Fenoglio, L.; Bracco, C.; Giraudo, A. V.; Testa, E.; Serraino, C.; Fargion, S.; Bonara, P.; Periti, G.; Porzio, M.; Peyvandi, F.; Tedeschi, A.; Rossio, R.; Monzani, V.; Savojardo, V.; Folli, C.; Magnini, M.; Gobbo, G.; Balduini, C. L.; Bertolino, G.; Provini, S.; Quaglia, F.; Dallegri, F.; Ottonello, L.; Liberale, L.; Chin, W. S.; Carassale, L.; Caporotundo, S.; Traisci, G.; De Feudis, L.; Di Carlo, S.; Liberato, N. L.; Buratti, A.; Tognin, T.; Bianchi, G. B.; Giaquinto, S.; Purrello, F.; Di Pino, A.; Piro, S.; Conca, A.; Falanga, L.; Montrucchio, G.; Greco, E.; Tizzani, P.; Petitti, P.; Perciccante, A.; Coralli, A.; Salmi, R.; Gaudenzi, P.; Gamberini, S.; Semplicini, A.; Gottardo, L.; Vendemiale, G.; Serviddio, G.; Forlano, R.; Masala, C.; Mammarella, A.; Basili, S.; Perri, L.; Landolfi, R.; Montalto, M.; Mirijello, A.; Vallone, C.; Bellusci, M.; Setti, D.; Pedrazzoli, F.; Guasti, Luigina; Castiglioni, L.; Maresca, ANDREA MARIA; Squizzato, Alessandro; Molaro, M.; Bertolotti, ; M., Ce; Mussi, C.; Libbra, M. V.; Miceli, A.; Pellegrini, E.; Carulli, L.; Sciacqua, A.; Quero, M.; Bagnato, C.; Corinaldesi, R.; De Giorgio, R.; Serra, M.; Grasso, V.; Ruggeri, E.; Salvi, A.; Leonardi, R.; Grassini, C.; Mascherona, I.; Minelli, G.; Maltese, F.; Gabrielli, A.; Mattioli, M.; Capeci, W.; Martino, G. P.; Messina, S.; Ghio, R.; Favorini, S.; Col, A. D.; Minisola, S.; Colangelo, L.; Afeltra, A.; Alemanno, P.; Marigliano, B.; Castellino, P.; Blanco, J.; Zanoli, L.; Cattaneo, M.; Fracasso, P.; Amoruso, M. V.; Saracco, V.; Fogliati, M.; Bussolino, C.; Durante, V.; Eusebi, G.; Tirotta, D.; Mete, F.; Gino, M.; Cittadini, A.; Arcopinto, M.; Salzano, A.; Bobbio, E.; Marra, A. M.; Sirico, D.; Moreo, G.; Scopelliti, F.; Gasparini, F.; Cocca, M.; Nieves, R. D.; Alberto, M. M.; Pedro, A. R.; Vanessa, L. P.; Lara, T.; Xavier, C. V.; Francesc, F.; Jesus, D. M.; Esperanza, B. T.; Behamonte Esther, D. C.; Maria, S. P.; Romero, M.; Blanca, P. L.; Cristina, L. G. C.; Victoria, V. G. M.; Saez, L.; Bosco, J.; Susana, S. B.; Marta, A. G.; Concepcion, G. B.; Antonio, F. M.; Hernandez, M. G.; Borrego, M. P.; Raquel, P. C.; Florencia, P. R.; Beatriz, G. O.; Sara, C. G.; Cervellera Alfonso, G. C.; Marta, P. M.; Alberto, R. C.; Antonio, A. A.; Montserrat, G. G.; Miguel Ángel, B. R.; Manuel, M. J.; Ignacio, N. V.; Lucía, A. S.; Alfonso, L.; David, R. B.; Iria, I. V.; Monica, R. P.; On behalf of REPOSI, Investigator
Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study
No full textBackground: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up
Prevalence and Determinants of the Use of Lipid-Lowering Agents 3 in a Population of Older Hospitalized Patients: the Findings 4 from the REPOSI (REgistro POliterapie Societa` Italiana di 5 Medicina Interna) Study
No full textBackground Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited.
Aim The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients.
Methods We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della SocietA Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy.
Results 2171 patients aged > 65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (>= 5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment.
Conclusion In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen
Pattern of in-hospital changes in drug use in the older people from 2010 to 2016
No full textPurpose: To assess the pattern of in-hospital changes in drug use in older patients from 2010 to 2016. Methods: People aged 65 years or more acutely hospitalized in those internal medicine and geriatric wards that did continuously participate to the REgistro POliterapie Societ\ue0 Italiana di Medicina Interna register from 2010 to 2016 were selected. Drugs use were categorized as 0 to 1 drug (very low drug use), 2 to 4 drugs (low drug use), 5 to 9 drugs (polypharmacy), and 10 or more drugs (excessive polypharmacy). To assess whether or not prevalence of patients in relation to drug use distribution changed overtime, adjusted prevalence ratios (PRs) was estimated with log-binomial regression models. Results: Among 2120 patients recruited in 27 wards continuously participating to data collection, 1882 were discharged alive and included in this analysis. The proportion of patients with very low drug use (0-1 drug) at hospital discharge increased overtime, from 2.7% in 2010 to 9.2% in 2016. Results from a log-logistic adjusted model confirmed the increasing PR of these very low drug users overtime (particularly in 2014 vs 2012, PR 1.83 95% CI 1.14-2.95). Moreover, from 2010 to 2016, there was an increasing number of patients who, on polypharmacy at hospital admission, abandoned it at hospital discharge, switching to the very low drug use group. Conclusion: This study shows that in internal medicine and geriatric wards continuously participating to the REgistro POliterapie Societ\ue0 Italiana di Medicina Interna register, the proportion of patients with a very low drug use at hospital discharge increased overtime, thus reducing the therapeutic burden in this at risk population
Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register
No full textBackground: Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. Methods: Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. Results: Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21\u20130.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38\u20131.87) and overall (HR 1.46, 95%CI 1.32\u20131.62) mortality, also after adjustment for age and sex. Conclusions: The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions
Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study.
No full textBACKGROUND:
Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited.
AIM:
The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients.
METHODS:
We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy.
RESULTS:
2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment.
CONCLUSIONS:
In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen
