Department of Clinical Pharmacology, University of Groningen, the Netherlands.
J Card Fail. 2010 Feb;16(2):135-41.e2. doi: 10.1016/j.cardfail.2009.09.006. Epub 2009 Nov 6.
Given the importance of patient safety and well-being, we quantified the likelihood and type of medication changes observed after 5 possible adverse effects (AE) perceived by heart failure (HF) patients.
We conducted a retrospective cohort study using 18 months follow-up data from the Coordinating study evaluating Outcomes of Advising and Counseling in HF study on 754 patients previously hospitalized for HF (NYHA II-IV, mean age 70 years). Data used for this secondary analysis included problem checklists that patients had completed at 3 points in time, and medication data collected from chart review. Changes in potential causal cardiovascular medication and relevant alleviating medication were classified. Within group and relative risks (RR) for medication changes were calculated. Of the 754 patients, 50% reported dizziness, 44% dry cough, 19% nausea, 19% diarrhea, and 12% gout on the first checklist. Overall, the likelihood of a medication change was increased by 38% after a perceived AE. Dry cough had the highest increased likelihood of an associated cardiovascular medication change (RR 1.83, CI 1.35-2.49). Patients reporting gout had a four fold higher likelihood of alleviating medication started or intensified.
A considerable number of HF patients perceived possible AE. However, the likelihood of medication being changed after a possible AE was rather low. There seems to be room for improving the management of AE.
鉴于患者安全和健康的重要性，我们量化了心力衰竭（HF）患者出现 5 种可能不良反应（AE）后观察到的药物变化的可能性和类型。
我们使用 Coordinating 研究中 18 个月的随访数据进行了回顾性队列研究，该研究评估了 HF 咨询和建议研究中 754 例因 HF 住院患者（NYHA II-IV，平均年龄 70 岁）的结局。用于此二次分析的数据包括患者在 3 个时间点完成的问题清单，以及从图表审查中收集的药物数据。将潜在因果心血管药物和相关缓解药物的变化进行分类。计算组内和相对风险（RR）的药物变化。在 754 例患者中，50%报告头晕，44%干咳，19%恶心，19%腹泻，12%痛风在第一张清单上。总体而言，在出现感知到的 AE 后，药物变化的可能性增加了 38%。干咳与心血管药物变化的关联具有最高的可能性增加（RR 1.83，CI 1.35-2.49）。报告痛风的患者开始或强化缓解药物的可能性高四倍。
相当多的 HF 患者感知到可能的 AE。然而，在出现可能的 AE 后，药物改变的可能性相当低。似乎有改进 AE 管理的空间。
