背景:关于老年社区居民中药物-药物相互作用(DDI)与健康结果之间关联的证据有限。
目的:我们估计潜在的临床重要DDI患病率,并检查DDI与(1)药物不良事件(ADE)之间的关联,(2)爱尔兰老年社区居民的急诊就诊和(3)与健康相关的生活质量(HRQoL)。
方法:这是一项前瞻性队列研究,研究对象是爱尔兰社区居住的老年人(N=904),年龄≥70岁,来自2010年招募的15个一般做法(第1波),并随访超过2年(第2波;2012-2013年),与相关的国家药房索赔数据。包括个体分配两种或更多种药物(波-1:N=842;波-2:N=763)。基线时的DDI患病率,对每个健康结局进行随访和6个月前的评估.使用多水平回归对DDI暴露与随访时健康结果之间的关联进行建模。DDI患病率,调整后的发病率比率(aIRR),调整后的赔率比(AOR),来自多层次回归分析的β系数和稳健标准误差(RSE),报告95%置信区间(CI)。
结果:在第1波时,n=196(23.3%[95%CI20.5-26.3]),个体可能暴露于≥1个DDI,在第2波时增加到n=345(45.2%[41.7-48.9])。在2年的随访中,ADE的中位数为3(四分位距[IQR2-5]);229(30.1%)的急诊就诊率≥1,平均EQ-5D为0.74(±0.23)。缺乏证据表明DDI暴露与后续急诊医院就诊之间存在关联(aOR=1.38[0.42-4.53])。DDI暴露与ADE数量的增加有关(aIRR=1.26[1.03-1.55]),并降低EQ-5D效用(β=-0.07,[-0.11至-0.04],RSE=0.02)。阿司匹林-华法林,克拉霉素-泼尼松龙,胺碘酮-呋塞米,克拉霉素-沙丁胺醇,瑞舒伐他汀-华法林,胺碘酮-比索洛尔,阿司匹林-尼可地尔是这些健康结局前6个月的常见DDI。
结论:我们发现在第1波和第2波之间DDI患病率增加了2倍。在2年的随访中,DDI暴露与ADE增加和HRQoL下降相关。常见的DDI涉及抗凝剂,心血管和抗菌药物,这应该是药物优化的目标。
BACKGROUND: Evidence on associations between drug-drug interactions (DDIs) and health outcomes in the older community-dwelling population is limited.
OBJECTIVE: We estimate potentially clinically important DDI prevalence and examine the association between DDIs and (1) adverse drug events (ADEs), (2) emergency hospital attendance and (3) health-related quality of life (HRQoL) in an older community-dwelling population in Ireland.
METHODS: This is a prospective cohort
study of community-dwelling older adults (N = 904) aged ≥ 70 years from 15 general practices in Ireland recruited in 2010 (wave-1) and followed-up over 2 years (wave-2; 2012-2013), with linked national pharmacy claims data. Individuals dispensed two or more drugs (wave-1: N = 842; wave-2: N = 763) were included. DDI prevalence at baseline, follow-up and 6 months prior to each health outcome was estimated. Multi-level regression was used to model the association between DDI-exposure and health outcomes at follow-up. DDI prevalence, adjusted incidence-rate ratios (aIRR), adjusted odds ratios (aOR), β coefficients and robust standard error (RSE) from multi-level regression analyses, and 95% confidence intervals (CIs) are reported.
RESULTS: At wave-1, n = 196 (23.3% [95% CI 20.5-26.3]), individuals were potentially exposed to ≥ 1 DDI, increasing to n = 345 (45.2% [41.7-48.9]) at wave-2. At 2-year follow-up, the median number of ADEs was 3 (interquartile range [IQR 2-5]); 229 (30.1%) had ≥ 1 emergency hospital attendance, and the mean EQ-5D was 0.74 (± 0.23). Evidence for the association between DDI-exposure and emergency hospital attendance at follow-up was lacking (aOR = 1.38 [0.42-4.53]). DDI-exposure was associated with an increasing number of ADEs (aIRR = 1.26 [1.03-1.55]), and decreasing EQ-5D utility (β = - 0.07, [-0.11 to -0.04], RSE = 0.02). Aspirin-warfarin, clarithromycin-prednisolone, amiodarone-furosemide, clarithromycin-salbutamol, rosuvastatin-warfarin, amiodarone-bisoprolol, and aspirin-nicorandil were common DDIs 6 months preceding these health outcomes.
CONCLUSIONS: We found a two-fold increase in DDI prevalence between wave 1 and 2. DDI exposure was associated with increasing ADEs and declining HRQoL at 2-year follow-up. Common DDIs involved anticoagulants, cardiovascular and antimicrobial drugs, which should be targeted for medicine optimisation.