门诊老年心力衰竭患者可诱发或加重心力衰竭药物处方情况及其影响因素分析

Analysis of prescription medications that may cause or exacerbate heart failure in elderly outpa⁃tients with heart failure and its influencing factors

目的了解老年心力衰竭(HF)患者门诊处方中可能加重HF药物的使用情况,并探讨其影响因素。方法收集2016年1月至2020年8月首都医科大学宣武医院门诊老年HF患者的处方,依据2016年美国心脏协会发布的可能诱发或加重HF的处方药(HF‑CEPM)目录,识别处方中的HF‑CEPM。从处方中提取患者的性别、年龄、疾病诊断、医疗保险、治疗药物、就诊科室、医师职称等信息,对处方中HF‑CEPM的使用进行描述性分析。根据处方中是否包含至少1种HF‑CEPM目录中的药物,将患者分为HF‑CEPM组和非HF‑CEPM组,比较2组患者的临床特征、用药种数、医疗保险、就诊科室和处方医师职称,采用多因素logistic回归方法分析处方HF‑CEPM的影响因素。结果共纳入2418例患者,其中男性1264例(52.27%),女性1154例(47.73%);中位年龄为80(65,99)岁;中位共病种数为1(0,5)种,需要长期服药治疗的前3位共病为高血压病(1233例,50.99%)、支气管哮喘(448例,18.53%)和糖尿病(385例,15.92%);中位用药种数为5(1,16)种。2418例患者中有254例(10.50%)使用了HF‑CEPM,其中男性142例(55.91%),女性112例(44.09%);使用1、2、3种HF‑CEPM的患者分别为224例(88.19%)、26例(10.24%)、4例(1.57%)。使用率在前5位的HF‑CEPM为抗高血压药[4.47%(108/2418)]、肺部用药[2.52%(61/2418)]、糖尿病用药[1.99%(48/2418)]、泌尿系统用药[1.12%(27/2418)]、解热镇痛药[1.03%(25/2418)]。多因素logistic回归分析结果显示,共病种数≥1种(1种:OR=3.732,95%CI:2.246~6.623,P<0.001;≥2种:OR=6.054,95%CI:3.624~10.788,P<0.001)和处方用药种数≥5种(OR=4.003,95%CI:2.874~5.693,P<0.001)是处方HF‑CEPM的独立影响因素。结论老年HF患者门诊处方中HF‑CEPM以抗高血压药、肺部用药、糖尿病用药、泌尿系统用药和解热镇痛药最为常见。门诊老年HF患者共病种数和多药治疗是处方HF‑CEPM的独立影响因素。

Objective To understand the prescription medications that may cause or exacerbate heart failure(HF‑CEPMs)in elderly outpatients with HF and analyze its influencing factors.Methods Prescriptions for elderly patients with HF in clinic of Xuanwu Hospital,Capital Medical University between January 2016 and August 2020 were collected.According to the list of HF‑CEPMs published by the American Heart Association in 2016,HF‑CEPMs in prescriptions were identified.The patient′s gender,age,disease diagnosis,medical insurance,therapeutic drugs,visiting departments,physician titles,and other information are extracted from the prescription,and the use of HF‑CEPMs in the prescription was descriptively analyzed.The patients were divided into HF‑CEPMs group and non‑HF‑CEPMs group according to whether the prescription included at least one drug in the list of HF‑CEPMs.The clinical characteristics,number of drugs,medical insurance,visiting departments,and professional titles of prescription physicians in patients in the 2 groups were compared,and the influencing factors of prescription containing HF‑CEPMs were analyzed by multivariate logistic regression.Results A total of 2418 patients were enrolled,including 1264 males(52.27%)and 1154 females(47.73%),with a median age of 80(65,99)years and a median number of comorbidities 1(0,5).The top 3 comorbidities requiring long‑term medication were hyperten‑sion(1233 patients,50.99%),bronchial asthma(448 patients,18.53%)and diabetes mellitus(385 patients,15.92%),and the median number of drugs was 5(1,16).Among the 2418 patients,254(10.50%)used HF‑CEPMs,including 142(55.91%)males and 112(44.09%)females.Two hundred and twenty‑four patients(88.19%),26 patients(10.24%),and 4 patients(1.57%)were treated with 1,2,and 3 kinds of HF‑CEPMs,respectively.The top 5 HF‑CEPMs in drug use rates were antihypertensive drugs[4.47%(108/2418)],pulmonary drugs[2.52%(61/2418)],antidiabetic drugs[1.99%(48/2418)],urological drugs[1.12%(27/2418)],antipyretic and analgesic drugs[1.03%(25/2418)].Multiple logistic regression analysis showed that the number of comorbidities≥1(1 kind of disease:OR=3.732,95%CI:2.246-6.623,P<0.001;more than 2 kinds of diseases:OR=6.054,95%CI:3.624-10.788,P<0.001)and the number of prescribed drugs≥5(OR=4.003,95%CI:2.874-5.693,P<0.001)were independent influencing factors for prescribing HF‑CEPMs.Conclusions Antihypertensive drugs,pulmonary drugs,antidiabetic drugs,urological drugs,and antipyretic and analgesics drugs were the most common HF‑CEPMs in outpatient prescriptions of elderly HF patients.The number of comorbidities and polypharmacy therapy in elderly outpatients with HF were independent influencing factors for prescribing HF‑CEPMs.