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住院时心血管疾病患者中潜在具有临床意义的药物相互作用的患病率及相关因素。

Prevalence and factors associated with potential clinically significant drug-drug interactions in patients with cardiovascular diseases at hospital admission.

作者信息

Marović Iva, Udovičić Mario, Rudan Diana, Manola Šime, Samardžić Ivana, Vrca Vesna Bačić, Hadžiabdić Maja Ortner, Marinović Ivana

机构信息

Department of Clinical Pharmacy, University Hospital Dubrava, 10000 Zagreb Croatia.

Clinic of Cardiology University Hospital Dubrava 10000 Zagreb, Croatia.

出版信息

Acta Pharm. 2025 Jan 9;74(4):693-708. doi: 10.2478/acph-2024-0038. Print 2024 Dec 1.

Abstract

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity globally. It is estimated that 17.9 million people died from CVDs in 2019, which represents 32 % of all deaths worldwide. Cardiovascular drugs are the most common medical intervention for the prevention of cardiovascular events. CV medications have many benefits however their application is often complicated by multimorbidity and polypharmacy. Drug-drug interactions (DDIs) can lead to adverse drug events, hospitalizations, prolonged hospital stays, increased healthcare costs, and increased risk of mortality. Hospital admission provides an opportunity for pharmacotherapy analysis and for identifying DDIs which can jeopardize medication safety. The aim of this study is to determine the type and prevalence of potential clinically significant DDIs in patients with CVD and to examine factors associated with exposure to DDIs. A prospective study was conducted at the Dubrava University Hospital at the Clinic of Cardiology during a 6-month period (September 2023 - February 2024). Demographic, clinical and pharmacotherapy data were collected for each patient. The first prescribed pharmacotherapy was analyzed. The research was approved by the Hospital's Ethics Committee and each patient involved in the study signed an informed consent. Lexicomp Lexi-InteractTM Online (Lexi-Comp, Inc., USA) was used for DDI analysis. Poisson regression was used for regression analysis for determining risk factors associated with exposure to DDIs. Total of 151 patients admitted to Cardiology ward were included in the research, and the average age was 67 years. Patients had an average of 9 medications in their therapy and 8 diagnoses. Overall, 1268 potential clinically significant DDIs were determined, of which the most frequently determined interactions were grade C (90.9 %), then grade D (8.6 %) and grade X (0.6 %). CV medications were involved in 88 % DDIs. The most common interventions regarding identified DDIs included exclusion one of the drugs, dose adjustment, increased monitoring of signs of bleeding, cardiac disorders, hypoglycemia, CNS depression and rhabdomyolysis, blood pressure, markers of renal function and electrolyte status. Factors associated with the prevalence of potential clinically significant DDIs were decreased renal function, recent hospitalization, total number of comorbidities and polypharmacy. Specific comorbidities associated with DDIs were arrhythmia, heart failure, diabetes mellitus and disease of the respiratory system. A high prevalence of DDIs of CV medications in all categories of clinical significance was determined. Managing medication safety in specific patient groups with CVDs can represent a greater challenge regarding DDIs. Certain medical conditions, such as arrhythmia, heart failure, diabetes, and diseases of the respiratory system, multimorbidity, polypharmacy, impaired renal function and recent hospitalization are identified in this research as additional factors associated with DDIs occurrence in patients with CVDs at hospital admission. Hospital admission is one of the crucial points for managing medication safety. Clinical pharmacists should regularly analyze DDIs in prescribed pharmaco-therapy which enhances medication safety and also contributes to the quality of provided health care.

摘要

心血管疾病(CVDs)是全球死亡率和发病率的主要原因。据估计,2019年有1790万人死于心血管疾病,占全球所有死亡人数的32%。心血管药物是预防心血管事件最常见的医学干预措施。心血管药物有许多益处,但其应用常常因多种疾病和多种药物治疗而变得复杂。药物相互作用(DDIs)可导致药物不良事件、住院、住院时间延长、医疗费用增加以及死亡风险增加。住院为药物治疗分析和识别可能危及用药安全的药物相互作用提供了机会。本研究的目的是确定心血管疾病患者中潜在临床显著药物相互作用的类型和发生率,并检查与药物相互作用暴露相关的因素。在2023年9月至2024年2月的6个月期间,于杜布拉瓦大学医院心脏病科进行了一项前瞻性研究。收集了每位患者的人口统计学、临床和药物治疗数据。对首次开具的药物治疗进行了分析。该研究获得了医院伦理委员会的批准,参与研究的每位患者均签署了知情同意书。使用Lexicomp Lexi-InteractTM Online(Lexi-Comp公司,美国)进行药物相互作用分析。采用泊松回归进行回归分析,以确定与药物相互作用暴露相关的危险因素。共有151名入住心脏病病房的患者纳入研究,平均年龄为67岁。患者治疗中平均有9种药物和8种诊断。总体而言,确定了1268种潜在临床显著药物相互作用,其中最常确定的相互作用为C级(90.9%),其次是D级(8.6%)和X级(0.6%)。心血管药物涉及88%的药物相互作用。关于已识别药物相互作用的最常见干预措施包括停用其中一种药物、调整剂量、加强对出血、心脏疾病、低血糖、中枢神经系统抑制和横纹肌溶解、血压、肾功能指标和电解质状态等体征的监测。与潜在临床显著药物相互作用发生率相关的因素包括肾功能下降、近期住院、共病总数和多种药物治疗。与药物相互作用相关的特定共病包括心律失常、心力衰竭、糖尿病和呼吸系统疾病。确定了各类临床意义上心脑血管药物药物相互作用的高发生率。在患有心血管疾病的特定患者群体中管理用药安全在药物相互作用方面可能面临更大挑战。本研究确定,某些医疗状况,如心律失常、心力衰竭、糖尿病和呼吸系统疾病、多种疾病、多种药物治疗、肾功能受损和近期住院,是入院时心血管疾病患者发生药物相互作用的其他相关因素。住院是管理用药安全的关键点之一。临床药师应定期分析处方药物治疗中的药物相互作用情况,这有助于提高用药安全性,也有助于提高所提供医疗保健的质量。

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