Expected and actual adverse drug-drug interactions in elderly patients accessing the emergency department: data from the ANCESTRAL-ED study

Marino, Angela; Capogrosso-Sansone, Alice; Tuccori, Marco; Bini, G; Calsolaro, Valeria; Mantarro, Stefania; Convertino, Irma; Pasqualetti, Giuseppe; Orsitto, E; Santini, Massimo; Monzani, Fabio; Blandizzi, Corrado

doi:10.1080/14740338.2016.1221400

Cited by 16 publications

(18 citation statements)

References 19 publications

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“…The studies included were conducted in Europe (n = 8) [31][32][33][34][35][36][37][38], Asia (n = 1) [39], and North America (n = 1) [40]. The methodological designs of the selected studies were: cross-sectional (n = 4) [34][35][36]40]; prospective longitudinal (n = 5) [31,33,[37][38][39]; and a single case-control (n = 1) [32]. There were large variations in sample sizes (82-3,473 patients).…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…To identify clinically manifested DDIs, medical records and ward visits (n = 7) [31][32][33][37][38][39][40] and medical records only (n = 3) [34][35][36] were used. The electronic databases used in the included studies were: Lexi-Comp1 (n = 3) [31,32,35], Micromedex1 (n = 3) [34,36,37], Stocley1 (n = 1) [33], and Epocrates1 (n = 1) [39]. Egger et al (2003) [38] did not report the database used to identify DDIs ( Table 1).…”

Section: Detection Of Drug Interactionsmentioning

confidence: 99%

“…participate in the detection of drug interactions [32,[34][35][36]40], and a pharmacist was a part of the team that evaluated the drug interactions in only three of the studies [33,37,38]. The severity of clinically manifested DDIs was reported in two studies [33,40].…”

Section: Plos Onementioning

confidence: 99%

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Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis

Santos¹,

Macieira²,

Alves³

et al. 2020

PLoS ONE

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This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. Methods PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. Results From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose.

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Section: Characteristics Of the Studiesmentioning

confidence: 99%

Section: Detection Of Drug Interactionsmentioning

confidence: 99%

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Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis

Santos¹,

Macieira²,

Alves³

et al. 2020

PLoS ONE

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“…This study is part of a larger prospective study on adverse drug reactions diagnosed at the ED of the University Hospital of Pisa (ANCESTRAL-ED) 22. In detail, older patients (aged >65 years) referred to the ED were consecutively enrolled at the triage area by a team comprising of geriatricians and pharmacologists.…”

Section: Methodsmentioning

confidence: 99%

“…The enrolled patients were allocated to the AF group according to Tinetti et al:22 […] an event which results in a person coming to rest unintentionally on the ground or other lower level, not as the result of a major intrinsic event (such as stroke) or overwhelming hazard.The absence of any prodrome (feeling of faint, palpitation, vertigo, and dizziness) before falling was added as further inclusion criterion. Patients were included in the syncope group according to the European Society of Cardiology Guideline on syncope:16

Syncope is a T-LOC due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery.

Finally, patients who experienced falls without a complete loss of consciousness but with prodrome and/or amnesia for the event were allocated to the UF group.…”

Section: Methodsmentioning

confidence: 99%

Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

Pasqualetti¹,

Calsolaro²,

Bini³

et al. 2017

CIA

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It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.

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A meta‐analysis assessing the prevalence of drug–drug interactions among hospitalized patients

Aksoy,

Ozturk

2023

Pharmacoepidemiology and Drug

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PurposeDrug–drug interactions (DDIs), particularly in hospitalized patients can result in adverse drug events and unfavorable health consequences. The aim of this meta‐analysis is to provide up‐to‐date evidence on the prevalence of clinically evident adverse drug events due to DDIs in hospitalized patients.MethodsData from Scopus, PubMed, Cochrane and Web of Science were extracted using these keywords (Drug interaction/drug–drug interactions, Hospital/ hospitals, Adverse drug event, Hospitalized patients, inpatient, Department, Hospital stay, Harm, Mortality, death). The studies that include Observational studies on hospitalized patients, reporting potential DDIs using an electronic database, and reporting the clinically observed adverse drug interactions (ADI) through symptoms, signs or Laboratory tests are included. Using Open meta‐Software (version 12.11.14), the incidence of clinically evident DDIs among hospitalized patients was determined and shown in a forest plot.ResultsOnly 15 of the 8261 articles found through a literature search met the inclusion criteria and reported the desired outcome. The pooled prevalence of potential drug–drug interactions is 64.9% (CI 95% 0.618–0.736). While clinically evident DDIs have a pooled frequency of 17.17% (CI 95% 0.133–0.256).ConclusionThe issue of DDIs remains a significant concern in hospitalized patients, with a notable rise in their prevalence. This meta‐analysis encompassed a greater quantity of studies and demonstrated a heightened proportion of drug–drug interaction prevalence in comparison to the percentages reported in the previously published meta‐analysis.

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Expected and actual adverse drug-drug interactions in elderly patients accessing the emergency department: data from the ANCESTRAL-ED study

Abstract: More than one half of elderly patients admitted to ED presented at least one expected DDI at the time of ED presentation. However, 9% of the expected DDIs were identified as actual DDIs, based on the consistency of the expected event with the ED discharge diagnosis.

Cited by 16 publications

References 19 publications

Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis

Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis

Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

A meta‐analysis assessing the prevalence of drug–drug interactions among hospitalized patients

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