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Excessive polypharmacy and survival in polypathological patients

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The purpose of this study was to determine whether excessive polypharmacy is associated with a higher survival rate in polypathological patients.

Patients and methods

An observational, prospective, and multicenter study was carried out on those polypathological patients admitted to the internal medicine and acute geriatrics departments between March 1 and June 30, 2011. For each patient, data concerning age, sex, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer’s questionnaire, socio-familial Gijon scale, delirium, number of drugs, and number of admissions during the previous year were gathered, and the PROFUND index was calculated. Polypharmacy was defined as the use of ≥5 drugs and excessive polypharmacy as the use of ≥10. A 1-year long follow-up was carried out. A logistic regression model was performed to analyze the association of variables with excessive polypharmacy and a Cox proportional hazard model to determine the association between polypharmacy and survival.

Results

We included 457 polypathological patients. Mean age was 81.0 (8.8) years and 54.5 % were women. The mean number of drugs used was 8.2 (3.4). Excessive polypharmacy was directly associated with heart disease [hazard ratio (HR) 2.33 95 % CI 1.40–3.87; p = 0.001], respiratory disease [HR 1.87 95 % CI 1.13–3.09; p = 0.01], peripheral artery disease/diabetes with retinopathy and/or neuropathy [HR 2.02 95 % CI 1.17–3.50; p = 0.01], and the number of admissions during the previous year [HR 1.21 96 %CI 1.01–1.44; p = 0.04]. It was inversely associated with delirium [HR 0.48 95 % CI 0.25–0.91; p = 0.02]. There were no statistical differences regarding the probability of 1-year survival between patients with no polypharmacy, with simple polypharmacy, and with excessive polypharmacy (0.66, 0.60, and 0.57, respectively, p = 0.12).

Conclusions

A greater use of drugs may not be harmful but is also not associated with a higher probability of survival in polypathological patients.

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Contributor statement

We assure that all authors included in the paper fulfill the criteria of authorship. J. Diez-Manglano, M. Giménez-López, V. Garcés-Horna, M. Sevil-Puras, E. Castellar-Otín, P. González-García, I. Fiteni-Mera, and T. Morlanes-Navarro designed the study and performed data collection. Data analysis was performed by J. Diez-Manglano. The manuscript was drafted by J. Diez-Manglano and M. Giménez-López, V. Garcés-Horna, M. Sevil-Puras, E. Castellar-Otín, P. González-García, I. Fiteni-Mera, and T. Morlanes-Navarro helped with its revision.

Conflict of interest

The authors declare no conflict of interest.

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Correspondence to Jesús Díez-Manglano.

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Appendix

Appendix

List of researchers of the PLUPAR study

Jesús Díez-Manglano, Patricia Al-Cheikh Felices, Esperanza Bejarano Tello, Esther del Corral Beamonte, Isabel Fiteni Mera, Vanesa Garcés Horna, Francisco Javier Gomes Martín, Mª Pilar Lambán Aranda, Rosa Mª Martínez Álvarez, Pablo Martínez Rodés, Eulalia Munilla López, Mª Jesús Pardo Díez, Santiago Alfonso Rubio Félix, María Sevil Puras, Carla Toyas Miazza (Internal Medicine Department, Hospital Royo Villanova, Zaragoza); Paz Revillo Pinilla, María Espuelas Monge, Mónica Odriozola Grijalba, Leticia Ollero Domenche (Internal Medicine Department, Hospital Universitario Miguel Servet, Zaragoza); Mercedes Clerencia Sierra (Geriatric Unit, Hospital Universitario Miguel Servet, Zaragoza); Begoña de Escalante Yangüela, María del Mar Rodero Roldán (Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza); Mariano Sebastián Royo, José Ramón Puertas, José Luis Cabrerizo García (Internal Medicine Department, Hospital General de la Defensa, Zaragoza); Ernesto García-Arilla Calvo, Beatriz Gamboa Huarte, Teresa Morlanes Navarro, Teresa Villar Sanpio, José Luis Bonafonte Marteles, María Elena Castro Vilela, Raquel Quílez Pina (Geriatric Unit, Hospital Nuestra Señora de Gracia, Zaragoza); Mercedes Giménez López, Rosa Ramos Ibáñez, Concepción Ortiz Domingo (Geriatric Unit, Hospital San Juan de Dios, Zaragoza); Aránzazu Caudevilla Martínez, Araceli Jimeno Sainz (Internal Medicine Department, Hospital Ernest Lluch, Calatayud, Zaragoza); Eva Calvo Beguería, Teresa Omiste Sanvicente (Internal Medicine Department Hospital San Jorge, Huesca); Elena Ubis Díez (Geriatric Unit, Hospital Sagrado Corazón, Huesca); Pablo Sánchez-Rubio Lezcano, Sonia Omatos Mangado, Jesús Santaliestra Grau, Elena Castellar Otín (Internal Medicine Department, Hospital de Barbastro, Huesca); Juan Vallés Noguero, Alfredo Zamora Mur (Geriatric Unit, Hospital de Barbastro, Huesca); Carmen Piqueras Serrano, María Salas Alcántara (Internal Medicine Department, Hospital de Alcañiz, Teruel); Ignacio García-Álvarez García, Javier Lerín Sánchez (Internal Medicine Department, Hospital Obispo Polanco, Teruel); Paloma González García, Sofía Solsona (Geriatric Unit, Hospital San José, Teruel).

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Díez-Manglano, J., Giménez-López, M., Garcés-Horna, V. et al. Excessive polypharmacy and survival in polypathological patients. Eur J Clin Pharmacol 71, 733–739 (2015). https://doi.org/10.1007/s00228-015-1837-8

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