基于Beers标准(2019版)评价河北省多种慢性病共存老年心力衰竭住院患者的潜在不适当用药

Evaluation of potential inappropriate medication in elderly hospitalized patients with multi-chronic disease and heart failure in Hebei Province based on Beers criteria(2019 edition)

目的基于Beers标准(2019版)对河北地区多种慢性病共存老年心力衰竭(简称心衰)住院患者的潜在不适当用药(PIM)进行调查,并结合各疾病专科诊疗指南进行深入分析,探讨其相关危险因素,为促进多种慢性病共存老年人群临床合理用药提供参考。方法2022年1月随机从河北省4家医疗机构信息系统中各抽取50例老年心衰住院患者的电子病历资料。根据纳入与排除标准,最终纳入135例符合标准的患者。基于Beers标准(2019版)对老年心衰住院患者的PIM情况进行评估,结合疾病诊疗指南深入用药分析评价,给出用药建议。采用多因素Logistic回归分析老年心衰住院患者发生PIM的影响因素。结果不同年龄、罹患疾病种类的老年心衰住院患者PIM发生率比较,差异均无统计学意义(P>0.05);不同性别、用药种类、肾小球滤过率(GFR)的老年心衰住院患者PIM发生率比较,差异均有统计学意义(P<0.05)。按PIM发生频率高低排序前3位依次为利尿剂、螺内酯、苯二氮[艹卓]类镇静催眠药物。38例患者存在53例次PIM,排名前3的药物分别为苯二氮[艹卓]类镇静催眠药物、地高辛和抗精神病药物。24例患者存在26例次PIM,其中慢性肾脏病4期或以上阶段患者使用非甾体抗炎药物、心衰患者使用非甾体抗炎药物、晕厥患者使用胆碱酯酶抑制剂的情况较多。86例患者存在117例次高风险用药,其中老年住院患者使用利尿剂情况最多;其次为≥75岁的患者使用新型口服抗凝药物利伐沙班及达比加群。21例患者存在22例次药物相互作用,其中老年住院患者联合使用肾素-血管紧张素系统抑制剂和保钾利尿剂情况最多,共出现12例次。22例肾功能不全患者存在25例次PIM情况,其中肌酐清除率<30 mL/min的老年住院患者使用螺内酯的情况最多,共出现14例次。多因素Logistic回归分析结果显示,回归方程的拟合度为83.2%,其中女性、用药种类≥20种、GFR<45 mL/(min·1.73 m^(2))是发生PIM的危险因素(P<0.05)。结论河北地区多种慢性病共存老年心衰住院患者的PIM发生率较高,女性、用药种类≥20种、GFR<45 mL/(min·1.73 m^(2))是发生PIM的危险因素,合理用药水平有待提高。

Objective To investigate the potentially inappropriate medication(PIM)in elderly hospitalized patients with multi-chronic disease and heart failure in Hebei province based on the Beers criteria(2019 edition)and to analyze the risk factors of PIM in combination with the diagnosis and treatment guidelines of each disease,so as to provide a reference for promoting clinical rational drug use in elderly patients with multi-chronic disease and heart failure.Methods The medical record information data of 50 elderly hospitalized patients with heart failure were randomly selected from the information systems of four medical institutions in Hebei Province in January 2022.According to the inclusion and exclusion criteria,135 patients were finally included.PIM in elderly hospitalized patients with heart failure was evaluated based on the Beers criteria(2019 edition),combined with the guidelines for the diagnosis and treatment of diseases,in-depth medication analysis and evaluation were conducted,and medication suggestions were given.Multivariate Logistic regression was used to analyze the influencing factors for PIM in elderly hospitalized patients with heart failure.Results There was no statistically significant difference in the incidence of PIM among elderly hospitalized patients with heart failure with different ages and diseases(P>0.05).There were statistically significant differences in the incidence of PIM among elderly hospitalized patients with heart failure with different genders,types of medication and glomerular filtration rate(GFR)(P<0.05).The top three PIM use were diuretics,spironolactone and benzodiazepines.Thirty-eight patients had 53 PIM,and the top three drugs were benzodiazepines,digoxin,and antipsychotic drugs.Twenty-four patients had 26 episodes of PIM,among which patients with chronic kidney disease stage 4 or above used non-steroidal anti-inflammatory drugs,patients with heart failure used non-steroidal anti-inflammatory drugs,and patients with syncope used cholinesterase inhibitors.There were 117 times of high-risk medication in 86 patients,and diuretics were used most frequently in elderly hospitalized patients.The second was the use of new oral anticoagulants rivaroxaban and dabigatran in patients≥75 years old.There were 22 drug interactions in 21 patients,of which 12 cases occurred in elderly hospitalized patients combined with renin-angiotensin system inhibitors and potassium sparing diuretics.Twenty-two patients with renal insufficiency had 25 PIM,among which the elderly hospitalized patients with creatinine clearance rate<30 mL/min used spironolactone most frequently,with a total of 14 PIM.Multivariate Logistic regression analysis showed that the fitting degree of regression equation was 83.2%.Female,the types of drugs≥20,and GFR<45 mL/(min·1.73 m^(2))were the risk factors for PIM in elderly hospitalized patients with heart failure(P<0.05).Conclusion The incidence of PIM in elderly hospitalized patients with multi-chronic diseases and heart failure in Hebei province is high.Female,the types of drugs≥20,and GFR<45 mL/(min·1.73 m^(2))are risk factors for PIM.The level of rational drug use needs to be improved.