The Association of Potentially Inappropriate Medication at Older Age With Cardiovascular Events and Overall Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

2017 ◽  
Vol 18 (3) ◽  
pp. 211-220 ◽  
Author(s):  
Dana Clarissa Muhlack ◽  
Liesa Katharina Hoppe ◽  
Janick Weberpals ◽  
Hermann Brenner ◽  
Ben Schöttker
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Older Age ◽  
Potentially Inappropriate Medication ◽  
Overall Mortality

scholarly journals Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Eyob Alemayehu Gebreyohannes ◽  
Daniela Fialova
Keyword(s):  
Risk Factors ◽  
Developing Countries ◽  
Literature Review ◽  
Developing Country ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Older Age ◽  
Potentially Inappropriate Medication ◽  
Older Population

<b><i>Background and Aim:</i></b> Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. <b><i>Methods:</i></b> We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). <b><i>Results:</i></b> We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16–2.51) was significantly associated with PIM use. <b><i>Conclusion:</i></b> This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.

scholarly journals PREDICTION OF CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY WITH ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES

2012 ◽  
Vol 59 (13) ◽  
pp. E2074 ◽  
Author(s):  
Charalambos Vlachopoulos ◽  
Dimitrios Terentes-Printzios ◽  
Nikolaos Ioakeimidis ◽  
Konstantinos Aznaouridis ◽  
Konstantinos Rokkas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Cohort Studies ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
All Cause Mortality

Systematic Review and Meta-Analysis on the Associations of Polypharmacy and Potentially Inappropriate Medication With Adverse Outcomes in Older Cancer Patients

2020 ◽  
Author(s):  
Li-Ju Chen ◽  
Kira Trares ◽  
Dana Clarissa Laetsch ◽  
Thi Ngoc Mai Nguyen ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Significance Level ◽  
All Cause Mortality ◽  
Older Cancer Patients

Abstract Background Both polypharmacy and potentially inappropriate medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and postoperative complications have been meta-analyzed previously. Methods A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least one out of five predefined adverse health outcomes in a population of older cancer patients (≥60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model. Results Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25–1.50]), hospitalization (1.53 [1.37–1.71]), treatment-related toxicity (1.22 [1.01–1.47]), and postoperative complications (1.73 [1.36–2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p &lt; .05 significance level (1.62 [0.98–2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08–1.88]) was observed but not with other adverse outcomes. Conclusions Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.

scholarly journals Intravenous Iron Decreases Rehospitalizations but Does not Change mortality in Patients Admitted with Acute Heart Failure and Iron Deficiency: A Systematic review and Meta-analysis

2021 ◽  
Author(s):  
Nischit Baral ◽  
Nabin Raj Karki ◽  
Imran Akram ◽  
Ashiya Khan ◽  
Govinda Adhikari ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Iron Deficiency ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Placebo Control ◽  
Hospitalization Rates ◽  
Iv Iron ◽  
Overall Mortality

Introduction: The role of intravenous (IV) iron in chronic heart failure has been well studied, however, its role in acute heart failure (AHF) is less well-known. Including the recent AFFIRM-HF trial, we performed a systematic review and meta-analysis to highlight the role of IV iron in AHF with iron deficiency. Hypothesis: We hypothesized that IV iron does not change mortality or heart failure re-hospitalization rates in patients with AHF with iron deficiency. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies published from inception till June 30, 2021. We searched PubMed, MEDLINE, EMBASE (embase.com), and Cochrane database including only RCTs and Cohort studies. We also included one prospective and one retrospective Cohort studies and two RCTs in our meta-analysis. Eligible studies included adults with AHF, left ventricular ejection fraction less than 40%-50%, and able to receive IV iron therapy. Outcomes included re-hospitalization rates and overall mortality from 30 days to 52 weeks post randomization (in one RCT). We used random-effects model calculating Risk Ratio (RR) with 95% confidence interval (95% CI) using Review Manger 5.4 software. I2statistics was used to assess heterogeneity. Results: There were total 1561 participants in both groups (IV iron and placebo/control) of four studies. The controls were comparable in both cohort studies and both the RCTs were well matched. Our results showed re-hospitalization in 278 of 833 (33.37%) patients in the IV iron/exposure group and 337 of 728 (0.46%) patients in the placebo/control group. The pooled result showed that the risk of re-hospitalization was comparable across both groups (RR 0.85, 95%CI 0.62-1.17; I2=45%, P=0.14). However, subgroup analysis, including RCTs only showed that IV iron decreases re-hospitalization rate by 28% compared to placebo (RR 0.72, 95% CI: 0.64, 0.82, I2=0%, P<0.00001) but did not improve mortality when compared to placebo (RR 0.97, 95% CI: 0.73, 1.30, I2 =0%). Conclusions: IV iron showed significant improvement in re-hospitalization rate for AHF hospitalizations in iron deficient patients but did not improve overall mortality. We need larger RCTs to further validate its effect on mortality.

scholarly journals Prevalence of Polypharmacy, Hyperpolypharmacy and Potentially Inappropriate Medication Use in Older Adults in India: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Akshaya S. Bhagavathula ◽  
Kota Vidyasagar ◽  
Manik Chhabra ◽  
Muhammed Rashid ◽  
Rishabh Sharma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
South India ◽  
Meta Analysis ◽  
Inappropriate Medication ◽  
Potentially Inappropriate Medication ◽  
Cross Sectional ◽  
North East India ◽  
North East ◽  
Pooled Prevalence

Background: Older people often receive multiple medications for chronic conditions, which often result in polypharmacy (concomitant use of 5‒9 medicines) and hyperpolypharmacy (concomitant use of ≥10 medicines). A limited number of studies have been performed to evaluate the prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) use in older people of developing countries. The present study aimed to investigate regional variations in the prevalence of polypharmacy, hyperpolypharmacy, and PIM use in older people (60 + years) in India.Methods: Studies were identified using Medline/PubMed, Scopus, and Google Scholar databases published from inception (2002) to September 31, 2020. Out of the total 1890 articles, 27 were included in the study.Results: Overall, the pooled prevalence of polypharmacy was 49% (95% confidence interval: 42–56; p &lt; 0.01), hyperpolypharmacy was 31% (21–40; p &lt; 0.01), and PIM use was 28% (24–32; p &lt; 0.01) among older Indian adults. Polypharmacy was more prevalent in North-east India (65%, 50–79), whereas hyperpolypharmacy was prevalent in south India (33%, 17–48). Region-wize estimates for the pooled prevalence of PIM use in India were as follows: 23% (21–25) in East, 33% in West (24–42), 17.8% in North (11–23), and 32% (26–38) in South India. The prevalence of PIM use in adults aged ≥70°years was 35% (28–42), in those taking more medications (≥5.5/day) was 27% (22–31), and in adults using a high number of PIMs (≥3) was 29% (22–36). Subgroup analysis showed that cross-sectional studies had a higher pooled prevalence of polypharmacy 55% (44–65) than cohorts 45% (37–54). Hyperpolypharmacy in inpatient care settings was 37% (26–47), whereas PIM use was higher in private hospitals 31% (24–38) than government hospitals 25% (19–31).Conclusion: Polypharmacy and hyperpolypharmacy are widely prevalent in India. About 28% of older Indian adults are affected by PIM use. Thus, appropriate steps are needed to promote rational geriatric prescribing in India.Systematic Review Registration: https://clinicaltrials.gov, identifier [CRD42019141037].

scholarly journals Erectile dysfunction severity and prediction of cardiovascular events and all-cause mortality: a systematic review and meta-analysis of cohort studies

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P5151-P5151 ◽  
Author(s):  
D. Terentes-Printzios ◽  
C. Vlachopoulos ◽  
N. Ioakeimidis ◽  
K. Aznaouridis ◽  
C. Stefanadis
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Cohort Studies ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
All Cause Mortality
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