【摘要】 目的 分析老年慢性心力衰竭(CHF)患者出院带药处方中的潜在不适当用药(PIMs)及其影响因素。方法 回顾性研究。连续选取2019年1月至2023年12月在北京大学人民医院心血管内科住院的年龄≥65岁的CHF患者702例。根据纳排标准,最终纳入294例,中位年龄74(69,81)岁,男性182例,占比61.9%。依据2023年Beers标准判定PIMs的发生情况,将患者分为PIMs组(263例)和无PIMs组(31例)。记录并比较两组患者基本信息、心功能分级、合并症及出院带药情况。采用多因素logistic回归分析CHF患者出院处方中PIMs发生风险的影响因素。结果 294例患者中,PIMs发生率为89.5%。与无PIMs组相比,PIMs组心房颤动患者比例更高(47.5%比22.6%,χ~2=6.977,P=0.012)。平均带药数量为(8.2±0.2)种,56.5%的患者出院带药数量5～9种,32.7%的患者出院带药数量≥10种。PIMs组患者平均出院带药数量比无PIMs组高[(8.5±0.2)种比(6.0±0.6)种,χ~2=-4.467,P<0.001]。两组不同出院带药数量分布之间比较差异有统计学意义(χ~2=59.309,P<0.001)。263例患者共计发生PIMs 737例次。230例(78.2%)患者存在谨慎使用的PIMs,173例(58.8%)存在避免使用的PIMs,90例(30.6%)存在潜在临床重要药物相互作用的PIMs,12例(4.1%)存在与肾功能相关及3例(1.0%)存在与心力衰竭相关的PIMs。最常见的PIMs为利尿剂313例次(42.5%)。多因素logistic回归分析显示,心房颤动(OR=3.300,95%CI:1.271～8.571,P=0.014)及出院带药数量>8种(OR=3.049,95%CI:1.181～7.868,P=0.021)为PIMs发生风险的独立影响因素。结论 老年CHF患者出院带药处方中PIMs发生率较高。心房颤动及出院带药数量>8种是老年CHF患者出院PIMs发生风险的独立影响因素。更多还原

【Abstract】 Objective To analyze the prevalence and influencing factors of potentially inappropriate medications(PIMs) in discharge prescriptions among elderly patients with chronic heart failure(CHF).Methods This was a retrospective study.A total of 702 patients aged≥65 years who were hospitalized in the department of cardiology at Peking University People’s Hospital from January 2019 to December 2023were consecutively screened.Based on the inclusion and exclusion criteria,294 patients were ultimately enrolled.The median age was 74(69,81) years,and 61.9% were males.PIMs were identified according to the 2023 Beers Criteria.Patients were classified into two groups:the PIMs group(263 cases) and the non-PIMs group(31 cases).Baseline characteristics,heart function classification,comorbidities,and discharge medications were collected and compared between groups.Multivariate logistic regression analysis was performed to explore factors associated with PIMs.Results Among the 294 patients,the prevalence of PIMs was 89.5%.Compared with the non-PIMs group,the PIMs group had a higher proportion of atrial fibrillation(47.5% vs.22.6%,χ~2=6.977,P=0.012).The mean number of discharge medications was8.2±0.2.Overall,56.5% of patients were prescribed 5-9 medications,and 32.7% were prescribed≥10medic ations at discharge.The average number of medications in the PI Ms group was higher than that in the non-PIMs group(8.5±0.2 vs.6.0±0.6,Z=-4.467,P<0.001).The distribution of discharge medication counts differed significantly(χ~2=59.309,P<0.001).737 PIM occurrences were identified in 263 patients.230 patients had PIMs that should be used with caution(78.2%),173 patients had PIMs that should be avoided(58.8%),90 patients had PIMs involving potentially clinically significant drug interactions(30.6%),12 patients had kidney-related PIMs(4.1%),and 3 patients had heart failure-related PIMs(1.0%).The most common PIMs were diuretics(42.5%).Multivariate logistic regression showed that atrial fibrillation(OR=3.300,95% CI:1.271-8.571,P=0.014) and discharge with more than 8medications(OR=3.049,95% CI:1.181-7.868,P=0.021) were independent risk factors for PIMs.Conclusions The prevalence of PIMs in discharge prescriptions is high among elderly CHF patients.Atrial fibrillation and the use of more than 8 discharge medications were indentified as independent risk factors for PIMs in this population.更多还原