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多重用药与心力衰竭患者衰弱之间有何关联？一项系统评价与荟萃分析。

What is the association of polypharmacy with frailty in heart failure? A systematic review and meta-analysis.

作者信息

Prokopidis Konstantinos, Testa Giuseppe Dario, Veronese Nicola, Dionyssiotis Yannis, McLean Joseph, Walker Lauren E, Sankaranarayanan Rajiv

机构信息

Department of Musculoskeletal Science & Ageing, University of Liverpool, Liverpool, United Kingdom.

Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy.

出版信息

J Frailty Sarcopenia Falls. 2024 Mar 1;9(1):51-65. doi: 10.22540/JFSF-09-051. eCollection 2024 Mar.

DOI:10.22540/JFSF-09-051
PMID:38444545
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10910251/
Abstract

This systematic review and meta-analysis aimed to explore the differences in the number of prescribed medications and polypharmacy risk between patients with heart failure (HF) and frailty vs. those with HF but without frailty. Eligible studies included observational or experimental studies in patients aged ≥50 years. Thirteen studies met the criteria and were included in the final analysis. Patients with frailty and HF exhibited a higher risk of polypharmacy (OR: 1.87, 95% CI 1.72 - 2.04, I = 0%, P < 0.01) compared to those without frailty. Results remained significant after adjusting for comorbidity status. Additionally, patients with frailty and HF were prescribed more medications compared to those without ( = 6; MD: 1.43, 95% CI 0.31 - 2.55, I = 94%, P = 0.01), with a high degree of heterogeneity. However, results were non-significant after adjustment for comorbidity status. Patients with HF and frailty have a higher need of polypharmacy compared to those without frailty, which may increase the risk of potentially inappropriate medications (PIM). Investigating the real-world prevalence of PIM may support clinicians in their routine assessment as part of a comprehensive management strategy in patients with HF and frailty.

摘要

本系统评价和荟萃分析旨在探讨心力衰竭（HF）合并衰弱患者与单纯HF但无衰弱患者在处方药物数量和多重用药风险方面的差异。符合条件的研究包括年龄≥50岁患者的观察性或实验性研究。13项研究符合标准并纳入最终分析。与无衰弱的患者相比，衰弱合并HF的患者多重用药风险更高（OR：1.87，95%CI 1.72 - 2.04，I² = 0%，P < 0.01）。在调整合并症状态后，结果仍然显著。此外，与无衰弱的患者相比，衰弱合并HF的患者处方药物更多（P = 0.01）（差异 = 6；MD：1.43，95%CI 0.31 - 2.55，I² = 94%），异质性程度较高。然而，在调整合并症状态后，结果无统计学意义。与无衰弱的患者相比，HF合并衰弱的患者多重用药需求更高，这可能会增加潜在不适当用药（PIM）的风险。调查PIM在现实世界中的患病率可能有助于临床医生在对HF合并衰弱患者进行综合管理策略的常规评估中发挥作用。

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