Rodriguez-Cillero Carla, Menu Didier, d'Athis Philippe, Perrin Sophie, Dipanda Mélanie, Asgassou Sanaa, Guepet Hélène, Mazen Emmanuel, Manckoundia Patrick, Putot Alain
Department of Geriatric Medicine, University Hospital, Dijon, France.
"Mutualité Sociale Agricole de Bourgogne", Dijon, France.
Int J Clin Pract. 2017 Aug;71(8). doi: 10.1111/ijcp.12975. Epub 2017 Jun 15.
Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients.
All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included.
Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide.
In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.
关于老年人使用呋塞米的处方模式知之甚少。我们描述了门诊老年患者使用呋塞米的处方情况。
回顾性纳入了所有年龄超过80岁、隶属于法国勃艮第地区社会农业互助保险计划且在2015年3月开具过医疗处方的患者。
在15141名中位年龄为86岁的患者中，女性占61.3%，3937名患者（26%）有呋塞米处方。严重心力衰竭是最常见的慢性合并症（27.7%）。几乎所有患者（98.7%的患者处方时长为3个月或更长）的呋塞米被视为长期治疗药物。长期使用呋塞米治疗的推荐适应症包括严重心力衰竭（50.9%）、慢性肾病（3%）和肝硬化（0.1%）。呋塞米的处方率随年龄增长而增加（81 - 85岁：20.4%，86 - 90岁：28.5%，91 - 95岁：35.6%，>95岁：42.7%，P <.001），且这种增加与推荐的心力衰竭治疗药物（β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂）的减少有关。开处方者大多是全科医生（81.3%）。不到一半使用呋塞米的患者进行了血浆电解质监测。
在这项大型研究中，四分之一的门诊患者被开具了长期疗程的呋塞米。服用呋塞米的患者中有一半患有严重心力衰竭。年龄与呋塞米使用的线性增加以及推荐的心力衰竭治疗处方的减少有关。这些处方中的很大一部分似乎不符合推荐标准。
