Excessive polypharmacy and survival in polypathological patients

Purpose The purpose of this study was to determine whether excessive polypharmacy is associated with a higher survival rate in polypathological patients. Patients and methods An observational, prospective, and multicenter study was carried out on those polypathological patients admitted to the inter...
Ausführliche Beschreibung

Purpose The purpose of this study was to determine whether excessive polypharmacy is associated with a higher survival rate in polypathological patients. Patients and methods An observational, prospective, and multicenter study was carried out on those polypathological patients admitted to the internal medicine and acute geriatrics departments between March 1 and June 30, 2011. For each patient, data concerning age, sex, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer’s questionnaire, socio-familial Gijon scale, delirium, number of drugs, and number of admissions during the previous year were gathered, and the PROFUND index was calculated. Polypharmacy was defined as the use of ≥5 drugs and excessive polypharmacy as the use of ≥10. A 1-year long follow-up was carried out. A logistic regression model was performed to analyze the association of variables with excessive polypharmacy and a Cox proportional hazard model to determine the association between polypharmacy and survival. Results We included 457 polypathological patients. Mean age was 81.0 (8.8) years and 54.5 % were women. The mean number of drugs used was 8.2 (3.4). Excessive polypharmacy was directly associated with heart disease [hazard ratio (HR) 2.33 95 % CI 1.40–3.87; p = 0.001], respiratory disease [HR 1.87 95 % CI 1.13–3.09; p = 0.01], peripheral artery disease/diabetes with retinopathy and/or neuropathy [HR 2.02 95 % CI 1.17–3.50; p = 0.01], and the number of admissions during the previous year [HR 1.21 96 %CI 1.01–1.44; p = 0.04]. It was inversely associated with delirium [HR 0.48 95 % CI 0.25–0.91; p = 0.02]. There were no statistical differences regarding the probability of 1-year survival between patients with no polypharmacy, with simple polypharmacy, and with excessive polypharmacy (0.66, 0.60, and 0.57, respectively, p = 0.12). Conclusions A greater use of drugs may not be harmful but is also not associated with a higher probability of survival in polypathological patients. Ausführliche Beschreibung