Identification of potentially inappropriate cardiovascular prescriptions in the elderly using Beers criteria / Criterios de Beers en la identificación de prescripciones de uso cardiovascular potencialmente inapropiadas en ancianos

Abstract Introduction: improper use of medication is becoming more frequent and can cause physical or physiological damage. Objective: to determine the frequency of potentially inappropriate prescriptions of cardiovascular drugs according to Beers' criteria in a population of colombian patients. Method: cross-sectional study conducted during november 2016 using a population database of 326,192 adults over 65 years of age who were eligible to receive drugs included in the cardiovascular system category according to the Beers' criteria. The frequency of potentially inappropriate prescriptions was determined and investigated in relation to sociodemographic variables. Results: the mean subject age was 74.6±7.6 years (range:65-100 years). It was found that 11.3% (n=36894) of the elderly presented at least one potentially inappropriate prescription for cardiovascular conditions. The most frequent finding was the use of aspirin in patients older than 80 years of age followed by the use of prazosin for hypertension in patients over 65 years of age or in patients who consulted emergency services for syncope. The other criteria were present in less than 1% of patients, and in 16 out of 33 treatment drugs, no patients exposed to potentially inappropriate prescriptions were found. Within the criteria based on drug-drug interactions, the most frequent were loop diuretics along with prazosin (6.4%). Conclusions: the prevalence of potentially inappropriate prescriptions in an elderly population of patients in Colombia is lower than that reported worldwide. In addition, there is a need to re-evaluate the Beers' criteria in this population and adjust the guidelines according to results of pharmacovigilance of active pharmaceutical substances available in Colombia.

Resumen Introducción: el uso incorrecto de medicamentos es cada vez más frecuente y puede causar daños físicos o fisiológicos. Objetivo: determinar la frecuencia de las prescripciones de medicamentos de uso cardiovascular potencialmente inapropiadas según criterios de Beers en una población de pacientes colombianos. Métodos: estudio de corte transversal, a partir de una base de datos de una población de 326.192 adultos mayores de 65 años, durante el mes de noviembre de 2016, susceptibles de recibir medicamentos incluidos en los criterios de Beers en la categoría de sistema cardiovascular, determinando la frecuencia de prescripciones potencialmente inapropiadas, así como la identificación de variables sociodemográficas. Resultados: la edad promedio fue de 74,6±7,6 años (rango 65-100 años). Se halló que el 11,3% (n=36894) de los ancianos tuvo al menos una prescripción potencialmente inapropiada para condiciones cardiovasculares. El criterio más frecuente fue el uso de aspirina en mayores de 80 años, seguido del empleo de prazosín para la hipertensión arterial en mayores de 65 años, o en pacientes que consultaron por síncope a los servicios de urgencias. Los demás criterios se presentaban en menos del 1% de pacientes y en 16 de 33 fármacos de cuidado no se halló ningún paciente expuesto. Entre los criterios basados en interacciones fármaco-fármaco, el más frecuente fue diuréticos de asa junto con prazosín (6,4%). Conclusiones: la prevalencia de prescripciones potencialmente inapropiadas en una población de ancianos colombianos es menor a la reportada en el mundo. Además, se plantea la necesidad de reevaluar los criterios de Beers en dicha población y ajustarlos de acuerdo con los informes de farmacovigilancia y principios activos disponibles en Colombia.

Factors related to excessive polypharmacy (≥15 medications) in an outpatient population from Colombia.

AIMS: To determine the frequency of excessive polypharmacy (≥15 medications) in an outpatient population from Colombia and the variables associated with this condition. METHODS: A cross-sectional study using a systematised database of 6.2 million affiliates of the Colombian Health System. All patients treated uninterruptedly with 15 or more medications for 3 months (January-March 2017) were included. Sociodemographic, pharmacological, potential drug interactions, and prescribers' variables were identified. RESULTS: A total of 264 patients with prescriptions of ≥15 medications were identified; with an estimated prevalence of excessive polypharmacy of 108.4 per 100 000 people. The mean age was 67.7 ± 17.8 years and 60.6% were females. The mean number of medications per patient was 20.1 ± 4.5 and 48.9% (n = 129) had 20 or more. The most used were antiulcer medications (89.0%; n = 235), antihypertensives (85.6%; n = 226), analgesic/antipyretic (80.3%; n = 212), psychiatric/neurologic medications (78.5%; n = 207), statins (67.4%; n = 178), acetylsalicylic acid (59.5%; n = 157), and vitamins (57.2%; n = 151). On average, each patient had 21.0 ± 11.4 drug-drug interactions and were attended by 6.2 ± 3.1 physicians. Being treated by seven or more physicians (OR: 5.09; 95% CI: 1.64-15.79) increased the probability of receiving more than 20 medications. CONCLUSIONS: Drugs for treatment of chronic conditions prevailed, especially in elderly patients with multiple chronic conditions; however, some groups of medications without clear indications, such as antiulcer medications or vitamin supplements, also had extensive use. A main factor that increases the probability of polypharmacy greater than 20 drugs is care by seven or more physicians, which shows a fragmentation in patient care by the country's health system, without achieving co-ordination and integration between the different agents involved in medical care, also influenced by different physicians' practice patterns.

Drugs With Anticholinergic Potential and Risk of Falls With Hip Fracture in the Elderly Patients: A Case-Control Study.

BACKGROUND/OBJECTIVE: To determine the association between the use of anticholinergic drugs and the risk of falls with hip fracture in a population older than 60 years. METHODS: A case-control study in patients older than 60 years with a diagnosis of hip fracture. All drugs dispensed during the previous 30 days were identified. Sociodemographic, clinical, pharmacological (drugs according to the Anticholinergic Risk Scale [ARS]), and polypharmacy variables were analyzed. MEASUREMENTS: Falls with hip fracture and type of drug according to the ARS. RESULTS: A total of 300 patients with hip fracture and 600 controls were included. The mean age was 81.6 ± 8.9 years, with female predominance (71.3%). The use of drugs with moderate (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.19-3.27) or high ARS scores (OR: 1.83, 95% CI: 1.13-2.96) increased the probability of fracture. CONCLUSIONS: There was an association between the use of drugs with anticholinergic properties and the probability of hip fracture in elderly patients and it was possible to establish the level of risk.

Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults.

ABSTRACTBackground:To determine the association between the use of opioids and benzodiazepines and the risk of falls with hip fracture in populations older than 65 years in Colombia. METHODS: A case-control study with patients older than 65 years with diagnosis of hip fracture. Two controls were obtained per case. The drugs dispensed in the previous 30 days were identified. Sociodemographic, diagnostic, pharmacological (opioids and benzodiazepines), and polypharmacy variables were analyzed. A logistic regression model was used to analyze the risk of fall with hip fracture while using these drugs. RESULTS: We included 287 patients with hip fractures and 574 controls. There was a female predominance (72.1%) and a mean age of 82.4 ± 8.0 years. Of the patients, 12.7% had been prescribed with opioids and 4.2% with benzodiazepines in the previous month. The adjusted multivariate analysis found that using opioids (OR:4.49; 95%CI:2.72-7.42) and benzodiazepines (OR:3.73; 95%CI:1.60-8.70) in the month prior to the event was significantly associated with a greater probability of suffering a fall with hip fracture. CONCLUSIONS: People who are taking opioids and benzodiazepines have increased risk for hip fracture in Colombia. Strategies to educate physicians regarding the pharmacology of older adults should be strengthened.

Severe and benign Plasmodium vivax malaria in Emberá (Amerindian) children and adolescents from an endemic municipality in Western Colombia.

Malaria in children is still an important public health problem in endemic areas of South-East Asia and Latin America. Certain forms of the disease, such as Plasmodium vivax severe malaria, are still neglected. This descriptive study assessed the frequency of severe and benign P. vivax infection in Emberá children (<14 years of age) from an endemic municipality in Colombia in 2013, using the WHO criteria. During 2013, 270 Emberá children presented 349 episodes of malaria. From them, 22 (8.1%) presented at least one of the criteria for severe malaria. Some patients with P. vivax presented with severe malaria (severe anemia, renal dysfunction, respiratory distress and seizure). Mixed malaria cases presented more complications than those with monoinfection (OR=5.535; 95%CI 1.81-16.9). In Colombia, few data are available about severe P. vivax malaria in children, especially in the Amerindian ethnic groups. Mixed infections were associated with increased risk of severe malaria. At the same time, detailed and prospective studies are needed to measure the real impact of severe vivax malaria, as was evidenced in this paper.

Scientific research in malaria: bibliometric assessment of the Latin-American contributions.

BACKGROUND: Malaria is a parasitic disease of high global impact in public health, including Latin America. There should be more researched, particularly in this region. A bibliometric assessment of the Latin American contributions about malaria was done. METHODS: Bibliometric study at SCI (1980-2013), MEDLINE/ GOPUBMED (1802-2013), Scopus (1959-2013), SCIELO (2004-2013), LILACS (1980-2013). The studies were characterized by study type, year of publication, city/country of origin, journals and more productive authors, citations and H index. RESULTS: At SCI, 2,806 articles were retrieved (5.13% of the total). Brazil was the highest producer (31.41%), followed by Colombia (14.3%) and Mexico (9.5%). The region received 39,894 citations, 32.2% from Brazil (H index=51), 12.75% Mexico (H index=38), 11.2% Colombia (H index=33). At Scopus, there are 4,150 articles (4.9% of the total), 33.0% Brazil, 11.3% Colombia and 8.8% Mexico; 17% in Brazil were from Universidad de São Paulo; 23.6% of Colombia from Universidad de Antioquia; 15.4% of Mexico from Instituto Nacional de Salud Pública. At Medline there were 4,278 records (36.8% Brazil). At SciELO there are 792 records (45.3% Brazil). At LILACS there were 1744 records (34.3% Brazil). CONCLUSIONS: Brazil has the highest output of the region, as Venezuela the scientific production in Malaria was related with the burden of disease. This was not the case for Colombia. Scientific production at bibliographical databases, particularly regionals, is low, compared to the high incidence of this disease that requires more research and control.