老年心血管病患者潜在性不适当用药及影响因素分析

目的:评价某院老年心血管病患者药物潜在不适当应用情况,并对其影响因素进行分析。方法:抽取某院2015年10月到2016年8月的老年心血管病例,以2014年版STOPP/START标准为依据,对年龄在65岁及以上的出院患者潜在不适当用药(PIM)进行评价,并采用多因素Logistic回归分析确定其影响因素。结果:通过病例筛选纳入514份病例,患者平均年龄(77.44±8.48)岁,平均罹患疾病数(5.93±2.34)种,联合用药总数(16.84±8.89)种;其中涉及2014年版STOPP标准不适当用药190例次,START标准处方遗漏419例次。单因素卡方分析提示,年龄(P=0.022)、罹患疾病数(P=0.041)、联合用药数(P=0.000)、心血管疾病史(P=0.001)及是否接受抗栓治疗(P=0.000)与PIM的发生具有相关性,且差异具有显著性(P<0.05);多因素Logistic回归分析提示稳定型心绞痛(OR=2.543,P=0.025),心房颤动(OR=2.304,P=0.024),冠状动脉粥样硬化(OR=2.659,P=0.005),联合用药数(≥10)(OR=1.040,P=0.026)及接受抗栓治疗(OR=3.037,P=0.007)的患者均会增加潜在不适当用药的风险,采用拟合的Logistic回归预测模型对入选病例预测总的预测正确率为74.5%。结论:老年心血管疾病患者发生潜在不适当用药是稳定型心绞痛、心房颤动、冠状动脉粥样硬化,联合用药数(≥10)及接受抗栓治疗多因素相互影响的结果。基于相关危险因素的PIM预防有助于减少不良事件的发生,促进临床合理用药。

Analysis of potentially inappropriate medication and risk factors in elderly patients with cardiovascular diseases

OBJECTIVE To evaluate potentially inappropriate medication (PIM) in elderly patients with cardiovascular diseases, analyze the risk factors of PIM. METHODS Cases of elderly patients with cardiovascular diseases in our hospital were selected from October 2015 to August 2016, based on the STOPP/START criteria 2014, to analyze the potentially inappropriate medication in patients over 65 years old with cardiovascular diseases. Binary Logistic regression was applied to statistical analysis for determining risk factors of PIM. RESULTS Five hundred and fourteen cases were selected with an average age of patients (77.44±8.48) years old. The average number of diseases was 5.93±2.34. The average number of medications that used for combination therapy for each patient was 16.84±8.89. There were 190 cases of inappropriate medication referred by STOPP and 419 cases for the standard omission of prescribed medications referred by the START. As the result of the χ² test, age (P=0.022), the number of diseases (P=0.041), the number of combined medications (P=0.000), history of cardiovascular diseases (P=0.001), and antithrombotic therapy (P=0.000) were related to PIM with significant differences (P<0.05). The multi-logistic regression indicated that stable angina pectoris (OR=2.543, P=0.025), atrial fibrillation (OR=2.304, P=0.024), coronary atherosclerosis (OR=2.659, P=0.005), the number of combined medications (≥ 10) (OR=1.040, P=0.026), and antithrombotic therapy (OR=3.037, P=0.007) would increase the risk of PIM. In addition, based on the fitting logistic regression model, there was a 74.5% accuracy rate for the prediction of risk within selected cases. CONCLUSION PIM in elderly patients results from the interaction of multiple factors including stable angina pectoris, atrial fibrillation, coronary atherosclerosis, the number of combined medications (≥ 10) and antithrombotic therapy. The prevention of PIM on the basis of related risk factors is beneficial to reducing adverse drug reactions and promoting the rational use of medicines.