Asociación entre el síndrome coronario agudo y el consumo de antiinflamatorios no esteroideos / Association between acute coronary syndrome and use of non steroidal anti-inflammatory drug

Objetivos: Evaluar el impacto cardiovascular asociado al consumo de antiinflamatorios no esteroideos en un Área de Salud, estimando la asociación entre la prescripción previa de un antiinflamatorio no esteroideo al episodio de síndrome coronario agudo. Material y Métodos: Se realiza un estudio retrospectivo observacional de casos cruzados de 5 años de duración, del 1 de Enero de 2008 hasta el 31 de diciembre de 2012. Los pacientes en primer lugar fueron casos y controles (n=1.317) que tuvieron eventos cardiovasculares y fueron al servicio de Urgencias del Hospital por dicho motivo.Área de Salud de Alcázar de San Juan. Medida principal: Asociación del riesgo de sufrir un síndrome coronario agudo mediante el Odds Ratio con el consumo de antiinflamatorios no esteroideos Resultados: La asociación entre el síndrome coronario agudo y el consumo de Antiinflamatorios fue positiva y significativa, (OR 1,42; IC95% 1,06-1,9). Esta asociación fue de mayor magnitud en pacientes con menor comorbilidad, Charlson ≤ 1 (OR 1,66; IC95% 1,15 - 2,40) frente a los de mayor comorbilidad, Charlson > 1 (OR 1,07; IC95% 0,65 - 1,76). Esta modificación de efecto se debió en parte al consumo concomitante de fármacos que previenen contra patologías cardiovasculares como los antiagregantes, anticoagulantes y estatinas. Conclusiones: El consumo de antiinflamatorios no esteroideos se ha asociado a un mayor riesgo de síndrome coronario agudo, por lo que es necesario realizar un seguimiento a los pacientes que consuman estos fármacos, no debiéndose tomar durante tiempos prolongados ni a dosis altas (AU)

Aims: Evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Area, by estimating the connection between the previous medical prescription of non steroidal anti-inflammatory medicines and acute coronary syndrome. Material and Methods: A retrospective observational study of clinical casecrosover during 5 years is done, from 1st of January 2008 to 31st of December 2012. In first place patients were cases and controls (n=1.317) who suffered cardiovascular accidents and went to Emergency Room. Setting: Alcazar de San Juan Health Care Area. Main measurements: Association of the risk of acute coronary syndrome by Odds Ratio with consumption of non anti-inflammatory drug. Results: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive and significant (OR 1.42; IC95% 1.06-1.9), which means the probability of suffering a cardiovascular accident increases to 42% in patients taking non steroidal anti-inflammatory drugs. The connection between the prescription of anti-inflammatory drugs and acute coronary syndrome reached a bigger magnitude in patients with less comorbidity, Charlson ≤ 1 (OR 1.66; IC95% 1.15 - 2.40) as opposite to those with more comorbidity, Charlson > 1 (OR 1.07; IC95% 0.65 - 1.76). This change of effect was due, in part, to the concomitant use of medicines which prevent cardiovascular diseases, such as antiaggregant, anticoagulant and statins drugs. Conclusions: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents; therefore it is necessary to realize follow-up patients who consume these drugs. These drugs must not be consumed for a long time or at high doses (AU)

Medication list assessment in Spanish hospital emergency departments.

BACKGROUND: Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. OBJECTIVES: This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. METHODS: We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. RESULTS: We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. CONCLUSIONS: The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.