Lucenteforte Ersilia, Lombardi Niccolò, Vetrano Davide Liborio, La Carpia Domenico, Mitrova Zuzana, Kirchmayer Ursula, Corrao Giovanni, Lapi Francesco, Mugelli Alessandro, Vannacci Alfredo
Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
Department of Geriatrics Catholic University, Rome, Italy.
Clin Interv Aging. 2017 Oct 19;12:1761-1778. doi: 10.2147/CIA.S137403. eCollection 2017.
Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP) exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator "and". The first regarded "prescriptions", the second "adverse events", the third "cardiovascular conditions", and the last was planned to identify studies on "older people". Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects aged ≥65 years; and observational effectiveness studies. The database searches produced 5,742 citations. After removing duplicates, titles and abstracts of 3,880 records were reviewed, and 374 full texts were retrieved that met inclusion criteria. Thus, 49 studies reporting 32 potential IP indicators were included in the study. IP indicators regarded mainly drug-drug interactions, cardio- and cerebrovascular risk, bleeding risk, and gastrointestinal risk; among them, only 19 included at least one study that showed significant results, triggering a potential warning for a specific drug or class of drugs in a specific context. This systematic review demonstrates that both cardiovascular and non-cardiovascular drugs increase the risk of adverse drug reactions in older adults with cardiovascular diseases.
对于医生来说，避免在老年患者中使用风险大于益处的药物是一项挑战，目前存在不同的标准来识别不适当处方（IP）以帮助开处方者。确定受心血管疾病和慢性合并症影响的意大利老年人群中的IP指标，对开处方者可能极为有用，并且从公共卫生角度来看可能具有优势。本研究的目的是通过系统的文献综述结合共识标准来确定IP指标。我们对PubMed、EMBASE和CENTRAL数据库进行了系统检索，检索围绕四个主题构建，并将每个主题与布尔运算符“and”相结合。第一个主题是“处方”，第二个是“不良事件”，第三个是“心血管疾病”，最后一个旨在识别关于“老年人”的研究。两名研究人员独立审查标题、摘要、全文，并根据以下纳入标准选择涉及心血管疾病老年患者IP的文章：对年龄≥65岁人群的研究；对年龄无限制但有≥65岁受试者数据的患者的研究；以及观察性有效性研究。数据库检索产生了5742条引文。去除重复项后，对3880条记录的标题和摘要进行了审查，检索到374篇符合纳入标准的全文。因此，本研究纳入了49项报告32个潜在IP指标的研究。IP指标主要涉及药物相互作用、心脑血管风险、出血风险和胃肠道风险；其中，只有19项指标至少包含一项显示显著结果的研究，这在特定背景下对特定药物或药物类别发出了潜在警告。这项系统综述表明，心血管药物和非心血管药物都会增加患有心血管疾病的老年人发生药物不良反应的风险。
