Prevalence and clinical implications of polypharmacy and potentially inappropriate medication in elderly patients with heart failure: results of six months' follow-up

OBJECTIVES To investigate the prevalence of polypharmacy and potentially inappropriate medication(PIM)in elderly patients with heart failure(HF)and their impact on readmission and mortality.METHODS We conducted a study of 274 participants aged 60 years or older with HF.The prevalence of polypharmacy(defined as the use of five or more medications)was calculated,and the 2019 American Geriatrics Society Beers criteria were applied to access PIMs.Medications and PIMs were characterized at admission and discharge,and changes in prescriptions during hospitalization were compared.The impact of polypharmacy and PIM on readmission and mortality were investigated.RESULTS The median age of this study population was 68 years old.The median number of prescribed drugs was 7 at admission and 10 at discharge.At discharge,99.27%of all patients were taking five or more drugs.The incidence of composite endpoint and cardiovascular readmission increased with the number of polypharmacy within 6 months.The use of guideline-directed medical therapy reduced the incidence of composite endpoint events and cardiovascular readmission,while the use of noncardiovascular medications increased the composite endpoint events.The frequency of PIMs was 93.79%at discharge.The incidence of composite endpoint events increased with the number of PIMs.“PIMs in older adults with caution”increased cardiovascular readmission and“PIMs based on kidney function”increased cardiovascular mortality.Several comorbidities were associated with cardiovascular mortality or non-cardiovascular readmission.CONCLUSIONS Polypharmacy and PIM were highly prevalent in elderly patients with HF,and their use was associated with an increased risk of composite endpoint events,readmission and mortality.Non-cardiovascular medications,“PIMs in older adults with caution”,“PIMs based on kidney function”and several comorbidities were important factors associated with hospital readmission and mortality.Our findings highlight the importance of medication optimization in the management of HF in elderly patients.

No association between low-dose reserpine use and depression in older hypertensive patient: result of a multicenter, cross-sectional study

Background Reserpine is currently used by millions of Chinese hypertensive patients, in spite of the continued concern of its depressogenic effect, even when used in low dose. This study aimed to investigate the association between low-dose reserpine use and depression in older Chinese hypertensive patient. Methods In this cross-sectional, case-control study, we recruited patient aged 60 years or over who had regularly taken one or two tables of “compound reserpine and triamterene tablets (CRTTs)” for more than one year (reserpine user) from 26 community health centers located in 10 provinces in China. For each patient who took CRTTs, we selected an age (within five years) and sex matched hypertensive patient who had never taken any drugs containing reserpine (non-reserpine user) as control. Depressive symptoms were evaluated using a Chinese depression scale adapted from the Zung Self-Rating Depression Scale. Demographic, clinical data and laboratory examination results within six months were collected. Results From August 2018 to December 2018, 787 reserpine user and 787 non-reserpine user were recruited. The mean age of all study subjects was 70.3 years, with about equal numbers of males and females. The mean depression score was 40.4 in reserpine users and 40.6 in non-reserpine users (P = 0.7). The majority of study subject had a depression score < 53 (87.6% in reserpine users and 88.2% in non-reserpine users, respectively). There were no significant differences in the prevalence of mild, moderate or severe depression in reserpine users and non-reserpine users. Conclusions There is no association between low-dose reserpine use and depression in older hypertensive patient. The role of reserpine in the treatment and control of hypertension should be reconsidered;and further studies, especially randomized, controlled clinical trials to compare efficacy and safety of reserpine and other widely recommended anti-hypertensive agents are needed.

Beneficial clinical effects of grape seed proanthocyanidin extract on the progression of carotid atherosclerotic plaques

BackgroundAtherosclerotic 匾显示局部缺血事件和它的出现是为临床的医生的一项困难的任务。葡萄种子 proanthocyanidin 摘录(GSPE ) 被报导了由在动物导致动脉粥样硬化患者匾的回归施加 antiatherogenic 效果试验性的研究。在这研究， GSPE 的 antiatherogenic 效果在 287 个病人与免费颈动脉 intima 媒介厚度(CIMT ) 随机被分到 GSPE 组的无征状的颈动脉匾或反常的匾诊断了的临床的 use.MethodsConsecutive 被调查了(n = 146 ) 或控制组(n = 141 ) 。在 GSPE 的病人口头上地每天组织收到的 GSPE 200 mg，当在控制组的病人仅仅在一个生活方式干预程序被注册时。颈动脉超声检查在基线被执行并且 6， 12， 24 个月在后续期间。吝啬的最大的 CIMT ( MMCIMT )，匾分数，脉管的事件是的匾和 ischemic 的 echogenicity recorded.ResultsAs 预计在治疗以后， GSPE 在 MMCIMT 前进导致了重要减小(在六个月以后的4.2%减少，4.9%在 12 个月以后减少，5.8%在 24 个月以后减少)并且为主要结果的匾分数(在六个月，在 12 个月以后的24.1%减少和在 24 个月以后的33.1%减少以后的10.9%减少)，当 MMCIMT 和匾分数稳定、平时，增加匾和不稳定的匾的数字也在 GSPE 的治疗以后减少了。而且，颈动脉匾能与 GSPE 消失在治疗以后。为在 GSPE 组的不稳定的咽峡炎的为临时的 ischemic 攻击( TIA )的发生率，动脉的 revascularization 过程，和医院重新接纳是统计上重要的更低( P = 0.02 ， 0.08 ， 0.002 ，分别地)与控制相比， group.ConclusionsGSPE 禁止了前进在 GSPE 的 MMCIMT 和减少的颈动脉匾尺寸对待病人，并且与扩大治疗， MMCIMT 上的优异功效和颈动脉匾发生了。而且， GSPE 组显示出临床的脉管的事件的更低的率。