Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh,, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
J Gerontol A Biol Sci Med Sci. 2012 Aug;67(8):867-74. doi: 10.1093/gerona/gls001. Epub 2012 Mar 1.
Background. Studies of drug-related hospitalizations have focused on adverse drug reactions, but few data are available on therapeutic failures (TFs) and adverse drug withdrawal events (ADWEs) leading to hospitalization among community-dwelling older adults. Thus, we sought to describe the prevalence of unplanned hospitalizations caused by TFs and ADWEs. In addition, we evaluated factors associated with these events in a nationally representative sample of older Veterans. Methods. This study included 678 randomly selected unplanned hospitalizations of older (age ≥ 65 years) Veterans between December 1, 2003, and November 9, 2006. The main outcomes were hospitalizations caused by a TF and/or an ADWE as determined by a pair of health professionals from review of medication charts and application of the Therapeutic Failure Questionnaire and/or Naranjo ADWE algorithm, respectively. Preventability (ie, medication error) of the admission was also assessed. Results. Thirty-four TFs and eight ADWEs involving 54 drugs were associated with 40 (5.9%) Veterans' hospitalizations; of these admissions, 90.0% (36/40) were rated as potentially preventable mostly due to medication nonadherence and suboptimal prescribing. The most common TFs that occurred were heart failure exacerbations (n = 8), coronary heart disease symptoms (n = 6), tachyarrhythmias (n = 3), and chronic obstructive pulmonary disease exacerbations (n = 3). Half (4/8) of the ADWEs that occurred were cardiovascular in nature. Multivariable logistic regression modeling indicated that black Veterans (adjusted odds ratio 2.92, 95% CI 1.25-6.80) were significantly more likely to experience a TF-related admission compared with white Veterans. Conclusions. TF-related unplanned hospitalizations occur more frequently than ADWE-related admissions among older Veterans. Almost all TFs and/or ADWEs are potentially preventable.
研究表明，药物相关住院的原因主要是药物不良反应，但对于因治疗失败（TF）和药物撤药事件（ADWE）而导致的社区居住老年患者住院的情况，数据较少。因此，我们旨在描述因 TF 和 ADWE 导致的非计划性住院的患病率。此外，我们还评估了这些事件在具有全国代表性的老年退伍军人样本中的相关因素。
本研究纳入了 2003 年 12 月 1 日至 2006 年 11 月 9 日期间随机选择的 678 例老年（年龄≥65 岁）退伍军人的非计划性住院。主要结局为因 TF 和/或 ADWE 导致的住院，这是由两名医疗保健专业人员根据药物图表回顾和应用治疗失败问卷和/或 Naranjo ADWE 算法确定的。还评估了入院的可预防（即药物错误）情况。
34 例 TF 和 8 例 ADWE 涉及 54 种药物，与 40 例（5.9%）退伍军人的住院相关；在这些住院中，90.0%（36/40）被认为是潜在可预防的，主要是由于药物不依从和处方不当。最常见的 TF 是心力衰竭恶化（n=8）、冠心病症状（n=6）、心动过速（n=3）和慢性阻塞性肺疾病恶化（n=3）。发生的 ADWE 中有一半（4/8）为心血管性质。多变量逻辑回归模型表明，与白人退伍军人相比，黑人退伍军人（调整后的优势比 2.92，95%可信区间 1.25-6.80）更有可能经历 TF 相关的入院。
与 ADWE 相关的入院相比，老年退伍军人中因 TF 导致的非计划性住院更为常见。几乎所有的 TF 和/或 ADWE 都是潜在可预防的。
