Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study
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- 作者：Carlos A Alvarez (1) (2)
Eric M Mortensen (2) (3)
Una E Makris (2) (3)
Dan R Berlowitz (4) (5)
Laurel A Copeland (6)
Chester B Good (7)
Megan E Amuan (5)
Mary Jo V Pugh (8)
1. Pharmacy Practice Department ; Texas Tech University Health Sciences Center ; Forest Park Rd ; Dallas ; TX ; USA
2. Clinical Science Department ; University of Texas Southwestern ; Harry Hines ; Dallas ; TX ; USA
3. Internal Medicine Department ; University of Texas Southwestern ; Harry Hines ; Dallas ; TX ; USA
4. Departments of Medicine and Health Policy and Management ; Boston University ; Springs Rd ; Bedford ; MA ; USA
5. Center for Healthcare Organization and Implementation Research ; Springs Rd ; Bedford ; MA ; USA
6. Center for Applied Health Research -Health Outcomes Core ; Central Texas Veterans Health Care System and Baylor Scott & White Health ; Birdcreek Dr ; Temple ; TX ; USA
7. Departments of Medicine and Pharmacy ; University of Pittsburgh ; University Dr C ; Pittsburgh ; PA ; USA
8. South Texas Veterans Healthcare System and the Department of Epidemiology and Biostatistics at the University of TX Health Science Center ; San Antonio ; TX ; USA - 关键词：Aged ; Antihistamines ; Skeletal muscle relaxant ; Adverse drug events ; Healthcare effectiveness data and information set ; Mortality ; Hospitalizations ; Emergency service
- 刊名：BMC Geriatrics
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：15
- 期：1
- 全文大小：65 KB
- 参考文献：1. Pugh MJ, Marcum ZA, Copeland LA, Mortensen EM, Zeber JE, No?l PH, Berlowitz DR, Downs JR, Good CB, Alvarez C, Amuan ME, Hanlon JT: The quality of quality measures: HEDIS(R) quality measures for medication management in the elderly and outcomes associated with new exposure. / Drugs Aging 2013,30(8):645-54. 10.1007/s40266-013-0086-8 CrossRef
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6. National Committe on Quality Assurance: / Drugs To Be Avoided In The Elderly. 2007. [http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2011/HEDIS2011NDCLicense/HEDIS2011FinalNDCLists.aspx]
7. Billups SJ, Delate T, Hoover B: Injury in an elderly population before and after initiating a skeletal muscle relaxant. / Ann Pharmacother 2011,45(4):485-91. 10.1345/aph.1P628 CrossRef
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10. Pugh MJ, Hanlon JT, Wang CP, Semla T, Burk M, Amuan ME, Lowery A, Good CB, Berlowitz DR: Trends in use of high-risk medications for older veterans: 2004 to 2006. / J Am Geriatr Soc 2011,59(10):1891-898. 10.1111/j.1532-5415.2011.03559.x CrossRef
11. Pugh MJ, Hanlon JT, Zeber JE, Bierman A, Cornell J, Berlowitz DR: Assessing potentially inappropriate prescribing in the elderly Veterans Affairs population using the HEDIS 2006 quality measure. / J Manag Care Pharm 2006,12(7):537-45.
12. Budnitz DS, Lovegrove MC, Shehab N, Richards CL: Emergency hospitalizations for adverse drug events in older Americans. / N Engl J Med 2011,365(21):2002-012. 10.1056/NEJMsa1103053 Cross - 刊物主题：Geriatrics/Gerontology; Aging; Rehabilitation;
- 出版者：BioMed Central
- ISSN：1471-2318
文摘
Background High-risk medication exposure in the elderly is common and associated with increased mortality, hospitalizations, and emergency department (ED) visits. Skeletal muscle relaxants and antihistamines are high-risk medications commonly prescribed in elderly patients. The objective of this study was to determine the association between skeletal muscle relaxants or antihistamines and mortality, hospitalizations, and emergency department visits. Methods This study used a new-user, retrospective cohort design using national Veteran Affairs (VA) data from 128 hospitals. Veterans ?5?years of age on October 1, 2005 who received VA inpatient/outpatient care at least once in each of fiscal year (FY) 2005 and FY 2006 were included. Exposure to skeletal muscle relaxants and antihistamines was defined by the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set measures for high-risk medications in the elderly. Primary outcomes identified within one year of exposure were death, ED visit, or hospitalization; ED visits or hospitalizations due to falls and fracture were also assessed. Propensity score matching (1 to 1 match) was used to balance covariates between exposed patients and non-exposed patients. Results In this cohort of 1,807,404 patients 55,566 patients were included in the propensity-matched cohort for skeletal muscle relaxants and 60,058 patients were included in the propensity-matched cohort for anti-histamines. Mortality was lower in skeletal muscle relaxants-exposed patients (adjusted odds ratio [AOR] 0.87, 95% CI 0.81-0.94), but risk of emergency care (AOR 2.25, 95% CI 2.16-2.33) and hospitalization (AOR 1.56, 95% CI 1.48-1.65) was higher for patients prescribed skeletal muscle relaxants. Similar findings were observed for emergency and hospital care for falls or fractures. Mortality (AOR 1.93, 95% CI 1.82-2.04), ED visits (AOR 2.35, 95% CI 2.27-2.43), and hospitalizations (AOR 2.21, 95% CI 2.11-2.32) were higher in the antihistamine-exposed group, with similar findings for falls and fractures outcomes. Conclusion Skeletal muscle relaxants and antihistamines are associated with an increased risk of ED visits and hospitalizations in elderly patients. Antihistamines were also associated with an increased risk of death, further validating the classification of these drug classes as “high risk-