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1.
Stud Health Technol Inform ; 290: 330-334, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879406

ABSTRACT

COVID-19 patients with multiple comorbid illnesses are more likely to be using polypharmacy to treat their COVID-19 disease and comorbid conditions. Previous literature identified several DDIs in COVID-19 patients; however, various DDIs are unrecognized. This study aims to discover novel DDIs by conducting comprehensive research on the FDA Adverse Event Reporting System (FAERS) data from January 2020 to March 2021. We applied seven algorithms to discover DDIs. In addition, the Liverpool database containing DDI confirmed by clinical trials was used as a gold standard to determine novel DDIs in COVID-19 patients. The seven models detected 2,516 drug-drug pairs having adverse events (AEs), 49 out of which were confirmed by the Liverpool database. The remaining 2,467 drug pairs tested to be significant by the seven models can be candidate DDIs for clinical trial hypotheses. Thus, the FAERS database, along with informatics approaches, provides a novel way to select candidate drug-drug pairs to be examined in COVID-19 patients.


Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , COVID-19/drug therapy , Databases, Factual , Drug Interactions , Drug-Related Side Effects and Adverse Reactions/epidemiology , Humans , Polypharmacy
2.
BMJ Open ; 12(4): e058016, 2022 04 06.
Article in English | MEDLINE | ID: covidwho-1784833

ABSTRACT

INTRODUCTION: Older patients with multimorbidity, polypharmacy and related complex care needs represent a growing proportion of the population and a challenge for healthcare systems. Particularly in transitional care (hospital admission and hospital discharge), medical errors, inappropriate treatment, patient concerns and lack of confidence in healthcare are major problems that may arise from a lack of information continuity. The aim of this study is to develop an intervention to improve informational continuity of care at the interface between general practice and hospital care. METHODS AND ANALYSIS: A qualitative approach will be used to develop our participatory intervention. Overall, 32 semistructured interviews with relevant stakeholders will be conducted and analysed. The stakeholders will include healthcare professionals from the outpatient setting (general practitioners, healthcare assistants, ambulatory care nurses) and the inpatient setting (clinical doctors, nurses, pharmacists, clinical information scientists) as well as patients and informal caregivers. At a series of workshops based on the results of the stakeholder analyses, we aim to develop a participatory intervention that will then be implemented in a subsequent pilot study. The same stakeholder groups will be invited for participation in the workshops. ETHICS AND DISSEMINATION: Ethical approval for this study was waived by the Ethics Committee of Goethe University Frankfurt because of the nature of the proposed study. Written informed consent will be obtained from all study participants prior to participation. Results will be tested in a pilot study and disseminated at (inter)national conferences and via publication in peer-reviewed journals. TRIAL REGISTATION NUMBER: Clinical Trials Register: registration number DRKS00027649.


Subject(s)
General Practice , Polypharmacy , Aged , Hospitals , Humans , Patient Discharge , Pilot Projects
4.
BMJ Open ; 12(3): e060295, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731282

ABSTRACT

OBJECTIVES: To study the association between polypharmacy and the risk of hospitalisation and death in cases of COVID-19 in the population over the age of 65. DESIGN: Population-based cohort study. SETTING: Quebec Integrated Chronic Disease Surveillance System, composed of five medico-administrative databases, in the province of Quebec, Canada. PARTICIPANTS: 32 476 COVID-19 cases aged over 65 whose diagnosis was made between 23 February 2020 and 15 March 2021, and who were covered by the public drug insurance plan (thus excluding those living in long-term care). We counted the number of different medications they claimed between 1 April 2019 and 31 March 2020. OUTCOME MEASURES: Robust Poisson regression was used to calculate relative risk of hospitalisation and death associated with the use of multiple medications, adjusting for age, sex, chronic conditions, material and social deprivation and living environment. RESULTS: Of the 32 476 COVID-19 cases included, 10 350 (32%) were hospitalised and 4146 (13%) died. Compared with 0-4 medications, polypharmacy exposure was associated with increased hospitalisations, with relative risks ranging from 1.11 (95% CI 1.04 to 1.19) for those using 5-9 medications to 1.62 (95% CI 1.51 to 1.75) for those using 20+. Similarly, the risk of death increased with the number of medications, from 1.13 (95% CI 0.99 to 1.30) for those using (5-9 medications to 1.97 (95% CI 1.70 to 2.27) (20+). Increased risk was mainly observed in younger groups. CONCLUSIONS: Polypharmacy was significantly associated with the risk of hospitalisations and deaths related to COVID-19 in this cohort of older adults. Polypharmacy may represent a marker of vulnerability, especially for younger groups of older adults.


Subject(s)
COVID-19 , Polypharmacy , Aged , Cohort Studies , Hospitalization , Humans , Quebec/epidemiology , SARS-CoV-2
5.
BMJ Open ; 12(2): e051238, 2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1685584

ABSTRACT

INTRODUCTION: The increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on person-centred care model. This article outlines a study protocol, which aims to explore the effects of the intervention to improve therapeutic adequacy in polymedicated elderly patients. METHODS AND ANALYSIS: An open, randomised, multicentre, controlled clinical trial. The study population includes polymedicated (≥8 prescription medications) patients ≥75 years old. In the intervention group, the multidisciplinary team (primary care pharmacist, family doctor and nurse) will meet to carry out multidimensional reviews (frailty, clinical complexity, morbidity and therapeutic adequacy) of the study subjects. If changes are proposed to the treatment plan, a clinical interview will be conducted with the patient to agree on changes in accordance with their preferences. Follow-up visits will be scheduled at 6 and 12 months. In the control group, where the usual clinical practice will be followed, the necessary data will be collected to compare the results.The key variables are the variation in the mean number of incidents (potentially inappropriate prescription) per patient, the number of medications, the number of changes implemented to the treatment plan and the variation in the number of hospital admissions. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the IDIAPJGol and by the University of Barcelona's Bioethics Commission. The results are expected to be published in peer reviewed open-access journals, and as part of a doctoral thesis. TRIAL REGISTRATION NUMBER: NCT04188470. Pre-results.


Subject(s)
Polypharmacy , Quality of Life , Aged , Humans , Patient Care Team , Patient-Centered Care , Primary Health Care , Randomized Controlled Trials as Topic
6.
Stud Health Technol Inform ; 289: 114-117, 2022 Jan 14.
Article in English | MEDLINE | ID: covidwho-1643434

ABSTRACT

Medications Dexamethasone, Remdesivir or Colchicine, used to treat COVID-19 patients, have significant interactions with other medications and the human genome. The study presented in this paper investigates how to use the Personalized Medicine Therapy Optimization Method (PM-TOM) to minimize these interactions in polypharmacy therapies of COVID-19 patients. We applied PM-TOM on the EMR database of Harvard Personal Genome Project (PGP), drug database DrugBank and Comprehensive Toxicogenomics Database (CTD) to analyze polypharmacy therapies augmented with these medications. The main finding is that these COVID-19 medications significantly increase the drug and gene interactions in partially optimized (or unoptimized) therapies, which is not the case in the fully optimized ones. For example, the test results show that in polypharmacy treatments for patients having between 3 and 8 conditions, the average number of drug and gene interactions in partially optimized therapies ranges from 3 to 18 after adding Remdesivir, 4.3 to 20 Colchicine, and 4.7 to 23 Dexamethasone. On the other hand, these interactions in fully optimized therapies range only 0.6 to 5.2, 1.2 to 7, and 2.7 to 11, respectively. These results suggest that polypharmacy therapies should be carefully examined before adding these medications. This recommendation applies to all other situations when polypharmacy patients may conduct new serious conditions, such as COVID-19, requiring additional medications with a high number of drug and gene interactions.


Subject(s)
COVID-19 , Pharmaceutical Preparations , Drug Interactions , Humans , Polypharmacy , SARS-CoV-2
9.
Int J Environ Res Public Health ; 18(19)2021 Sep 29.
Article in English | MEDLINE | ID: covidwho-1444200

ABSTRACT

Given the continent's growing aging population and expanding prevalence of multimorbidity, polypharmacy is an increasingly dire threat to the health of persons living in Africa. The COVID-19 pandemic has only exacerbated these issues. Widespread misinformation, lack of vaccine access, and attempts to avoid being infected have resulted in increases in Africans' willingness to take multiple prescription and nonprescription medications and supplements. Issues with counterfeit pharmaceuticals and the relatively new recognition of emergency medicine as a specialty across the continent also create unique challenges for addressing this urgent public health need. Experts have called for more robust pharmaceutical regulation and healthcare/public health infrastructure investments across the continent. However, these changes take time, and more near-term strategies are needed to mitigate current health needs. In this commentary, we present a nonexhaustive set of immediately implementable recommendations that can serve as local strategies to address current polypharmacy-related health needs of Africans. Importantly, our recommendations take into consideration that not all healthcare providers are emergency medicine trained and that local trends related to polypharmacy will change over time and require ever-evolving public health initiatives. Still, by bolstering training to safeguard against provider availability biases, practicing evidence-based prescribing and shared decision making, and tracking and sharing local trends related to polypharmacy, African healthcare providers and public health practitioners can better position themselves to meet population needs. Furthermore, although these recommendations are tailored to Africans, they may also prove useful to providers and practitioners in other regions facing similar challenges.


Subject(s)
COVID-19 , Polypharmacy , Aged , Aging , Health Personnel , Humans , Pandemics , Public Health , SARS-CoV-2
10.
Qual Life Res ; 31(1): 193-204, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1279478

ABSTRACT

PURPOSE: We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic. METHODS: A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates. RESULTS: Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (- 9%, adjusted ß: - 0.047, 95% confidence interval - 0.089 to - 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (- 16%, adjusted ß: - 0.068, 95% confidence interval - 0.129 to - 0.008, p = 0.028) and total HRQoL. CONCLUSION: Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.


Subject(s)
COVID-19 , Dyslipidemias , Hypertension , Adult , Cross-Sectional Studies , Dyslipidemias/drug therapy , Dyslipidemias/epidemiology , Greece/epidemiology , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Pandemics , Polypharmacy , Quality of Life/psychology , SARS-CoV-2
11.
Sci Rep ; 11(1): 12414, 2021 06 14.
Article in English | MEDLINE | ID: covidwho-1268007

ABSTRACT

Primary aim was to assess prevalence and severity of potential and real drug-drug interactions (DDIs) among therapies for COVID-19 and concomitant medications in hospitalized patients with confirmed SARS-CoV-2 infection. The secondary aim was to analyze factors associated with rDDIs. An observational single center cohort study conducted at a tertiary hospital in Spain from March 1st to April 30th. rDDIs refer to interaction with concomitant drugs prescribed during hospital stay whereas potential DDIs (pDDIs) refer to those with domiciliary medication. DDIs checked with The University of Liverpool resource. Concomitant medications were categorized according to the Anatomical Therapeutic Chemical classification system. Binomial logistic regression was carried out to identify factors associated with rDDIs. A total of 174 patients were analyzed. DDIs were detected in 152 patients (87.4%) with a total of 417 rDDIs between COVID19-related drugs and involved hospital concomitant medication (60 different drugs) while pDDIs were detected in 105 patients (72.9%) with a total of 553 pDDIs. From all 417 rDDIs, 43.2% (n = 180) were associated with lopinavir/ritonavir and 52.9% (n = 221) with hydroxychloroquine, both of them the most prescribed (106 and 165 patients, respectively). The main mechanism of interaction observed was QTc prolongation. Clinically relevant rDDIs were identified among 81.1% (n = 338) ('potential interactions') and 14.6% (n = 61) (contraindicated) of the patients. Charlson index (OR 1.34, 95% IC 1.02-1.76) and number of drugs prescribed during admission (OR 1.42, 95% IC 1.12-1.81) were independently associated with rDDIs. Prevalence of patients with real and pDDIs was high, especially those clinically relevant. Both comorbidities and polypharmacy were found as risk factors independently associated with DDIs development.


Subject(s)
COVID-19/drug therapy , Drug Interactions , Hydroxychloroquine/chemistry , Lopinavir/chemistry , Ritonavir/chemistry , Aged , Analgesics/chemistry , Analgesics/therapeutic use , COVID-19/pathology , COVID-19/virology , Cardiovascular Diseases/drug therapy , Cohort Studies , Diuretics/chemistry , Diuretics/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Lopinavir/therapeutic use , Male , Middle Aged , Nervous System Diseases/drug therapy , Polypharmacy , Risk Factors , Ritonavir/therapeutic use , SARS-CoV-2/isolation & purification , Severity of Illness Index , Spain
12.
J Am Pharm Assoc (2003) ; 61(5): e14-e25, 2021.
Article in English | MEDLINE | ID: covidwho-1243031

ABSTRACT

BACKGROUND: Polypharmacy, the concomitant use of 5 or more medications, is highly prevalent among older adults and individuals with multimorbid conditions and has been linked to suboptimal clinical outcomes in various diseases. However, little is known about the impact of polypharmacy on clinical outcomes among coronavirus disease 2019 (COVID-19) patients. OBJECTIVE: This systematic review summarizes the available literature on the association between polypharmacy and specific drug classes, and clinical outcomes among COVID-19 patients. METHODS: We conducted an electronic database search on Embase, Medline, Cochrane, Scopus, Google Scholar, clinicaltrials.gov, LITCOVID, PubMed, PubMed Central (PMC), and China national knowledge infrastructure for studies on Polypharmacy among COVID-19 patients using relevant combinations of the keywords. Only studies published between November 2019 to September 2020 were included. Seven articles out of 1502 unique articles met the inclusion criteria and were used for the current study. We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in conducting and reporting this systematic review. RESULTS: The total sample size of all studies was 474,342, out of which 10,519 patients were COVID-19 positive, and 4818 COVID-19 positive patients experienced polypharmacy. Five out of the 7 included studies found associations between polypharmacy and negative clinical outcomes among COVID-19 patients. Polypharmacy was associated with increase in the relative risk of a positive COVID-19 test result (P < 0.01), death among male COVID-19 patients (P < 0.001), increase in the rate of acute kidney injury (P = 0.003), and adverse drug reactions (P < 0.001). Antipsychotic drugs were associated with severe COVID-19 morbidity (OR = 2.79; 95% CI 2.23-3.49) and increased risk of death among COVID-19 infected men (OR = 1.71; 95% CI 1.18-2.48) and women (OR = 1.96; 95% CI 1.41-2.73). CONCLUSION: Polypharmacy and selected drug classes are associated with increased risk of adverse clinical outcomes among COVID-19 patients. Understanding these relationships can enhance risk stratification and evidence-based decision-making that may improve care and clinical outcomes of COVID-19 patients.


Subject(s)
COVID-19 , Polypharmacy , Aged , China , Female , Humans , Male , SARS-CoV-2
13.
Pan Afr Med J ; 38: 220, 2021.
Article in English | MEDLINE | ID: covidwho-1239173

ABSTRACT

INTRODUCTION: elderly frequently present a poly-pathology recurring polypharmacy. Therefore, strict medication adherence is essential to avoid poor health outcomes especially during health crises like the current COVID-19 pandemic. The aims of our study were to identify the predictors of medication non-adherence in elderly and to expose the role of the emergency department (ED) to improve the therapeutic adherence during COVID-19 pandemic. METHODS: it was a two steps study. Primary, an observational, prospective survey over one month, including 100 elderly patients consulting to the emergency department. Medication adherence was assessed by Morisky's 4-questions scale; predictors of non-adherence have been identified. Secondary, a report of elderly medication management by the emergency physicians during the COVID-19 pandemic confinement. RESULTS: first step: 100 patients, mean age of 73±8 years. The average number of drugs was 4±2. Medication non-adherence was reported in 39%, predictors of therapeutic non-adherence were: polypharmacy (OR=2.41; CI95% [1.60;3.61]), rural origin (OR=6.72; CI95% [1.47;30.63]) and metabolic diseases history (OR=5.24; CI95% [1.48;18.53]). In the second step, 816 elder lies were enrolled, mean age: 73±7 years. The therapeutic attitude in the emergency department was to prescribe the same treatment (60%) to adjust the doses of the drugs prescribed (14%) to stop one or more drugs (13%) or to indicate new treatments (13%). Thirty-five percent of patients were admitted for short-term hospitalization. CONCLUSION: medication non-adherence is common in elderly, due to several factors. During the COVID-19 pandemic, the emergency services in Tunisia played an important role in the follow-up and therapeutic continuity of these elderly patients.


Subject(s)
COVID-19 , Emergency Service, Hospital/statistics & numerical data , Medication Adherence/statistics & numerical data , Polypharmacy , Aged , Aged, 80 and over , Female , Hospitalization/statistics & numerical data , Humans , Male , Prospective Studies , Tunisia
14.
Biomed Pharmacother ; 140: 111685, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1235862

ABSTRACT

Type 2 diabetes mellitus, obesity, hypertension, and other associated metabolic complications have been demonstrated as a crucial contributor to the enhanced morbidity and mortality of patients with coronavirus disease 2019 (COVID-19). Data on the interplay between metabolic comorbidities and the outcomes in patients with COVID-19 have been emerging and rapidly increasing. This implies a mechanistic link between metabolic diseases and COVID-19 resulting in the exacerbation of the condition. Nonetheless, new evidences are emerging to support insulin-mediated aggressive glucose-lowering treatment as a possible trigger of high mortality rate in diabetic COVID-19 patients, putting the clinician in a confounding and difficult dilemma for the treatment of COVID-19 patients with metabolic comorbidities. Thus, this review discusses the pathophysiological link among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), angiotensin-converting enzyme 2 (ACE2), metabolic complications, and severe inflammation in COVID-19 development, especially in those with multi-organ injuries. We discuss the influence of several routinely used drugs in COVID-19 patients, including anti-inflammatory and anti-coagulant drugs, antidiabetic drugs, renin-angiotensin-aldosterone system inhibitors. Especially, we provide a balanced overview on the clinical application of glucose-lowering drugs (insulin and metformin), angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers. Although there is insufficient evidence from clinical or basic research to comprehensively reveal the mechanistic link between adverse outcomes in COVID-19 and metabolic comorbidities, it is hoped that the update in the current review may help to better outline the optimal strategies for clinical management of COVID-19 patients with metabolic comorbidities.


Subject(s)
COVID-19/drug therapy , Metabolic Diseases/drug therapy , Pharmaceutical Preparations/administration & dosage , SARS-CoV-2/drug effects , Animals , Comorbidity , Humans , Polypharmacy
15.
Expert Opin Drug Saf ; 20(10): 1191-1206, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1221424

ABSTRACT

Introduction: The use of potentially inappropriate medications (PIM) is an alarming social risk factor in cardiovascular patients. PIM administration may result in iatrogenic disorders and adverse consequences may be attenuated by limiting PIM intake.Areas covered: The goal of this review article is to discuss the trends, risks, and concerns regarding PIM administration with focus on cardiovascular patients. To find data, we searched literature using electronic databases (Pubmed/Medline 1966-2021 and Web of Science 1975-2021). The data search terms were cardiovascular diseases, potentially inappropriate medication, potentially harmful drug-drug combination, potentially harmful drug-disease combination, drug interaction, deprescribing, and electronic health record.Expert opinion: Drugs for heart diseases are the most commonly prescribed medications in older individuals. Despite the availability of explicit and implicit PIM criteria, the incidence of PIM use in cardiovascular patients remains high ranging from 7 to 85% in different patient categories. Physician-induced disorders often occur when PIM is administered and adverse effects may be reduced by limiting PIM intake. Main strategies promising for addressing PIM use include deprescribing, implementation of systematic electronic records, pharmacist medication review, and collaboration among cardiologists, internists, geriatricians, clinical pharmacologists, pharmacists, and other healthcare professionals as basis of multidisciplinary assessment teams.


Subject(s)
Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Inappropriate Prescribing/trends , Potentially Inappropriate Medication List/trends , Antiviral Agents/adverse effects , COVID-19/drug therapy , Cardiovascular Agents/adverse effects , Drug Interactions , Humans , Inappropriate Prescribing/adverse effects , Polypharmacy , Risk Assessment , Risk Factors
17.
BMC Med ; 19(1): 51, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1094033

ABSTRACT

BACKGROUND: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. METHODS: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. RESULTS: Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. CONCLUSIONS: Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. REGISTRATION: ENCEPP number EUPAS35558.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Critical Care/trends , Polypharmacy , Psychotropic Drugs/adverse effects , Severity of Illness Index , Aged , Aged, 80 and over , COVID-19/chemically induced , Case-Control Studies , Comorbidity , Dose-Response Relationship, Drug , Drug Prescriptions , Female , Humans , Male , Middle Aged , Psychotropic Drugs/therapeutic use , Scotland/epidemiology
18.
Br J Community Nurs ; 26(1): 18-25, 2021 Jan 02.
Article in English | MEDLINE | ID: covidwho-1068039

ABSTRACT

Heart failure as a comorbidity in the older population with COVID-19 poses an additional threat to those affected. Patients with both COVID-19 and heart failure share similar risk factors, which result in magnification of pathological outcomes. These include a common inflammatory pathology and related coagulopathy. Both illnesses pose a risk of arrhythmia. Polypharmacy further complicates safe drug administration and worsens the risk of medication-induced arrhythmia. Additionally, both conditions present challenges regarding attaining and maintaining an appropriate nutritional state. Exploration of the interplay between these factors demonstrates the gravity of the co-existence of these conditions and helps understand the difficulties faced when caring for this patient group. Although care provided to COVID-19 patients is primarily related to symptom presentation, based on the analysis conducted, there are some recommendations for practice in relation to evidence and guidelines when managing heart failure patients in primary care within the context of the COVID-19 pandemic.


Subject(s)
COVID-19/complications , Heart Failure/complications , Heart Failure/therapy , Angiotensin-Converting Enzyme 2/genetics , Arrhythmias, Cardiac/etiology , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/physiopathology , Cytokine Release Syndrome/physiopathology , Diet , Gene Expression , Heart Failure/drug therapy , Heart Failure/physiopathology , Humans , Pandemics , Polypharmacy , Primary Health Care , Risk Factors , SARS-CoV-2/pathogenicity
19.
Rev Esp Quimioter ; 34(2): 145-150, 2021 Apr.
Article in Spanish | MEDLINE | ID: covidwho-1058742

ABSTRACT

OBJECTIVE: Despite the impact of SARS-CoV-2 infection in geriatrics, data on nonagenarian patients is scarce. The aim of this study is to describe the clinical features of COVID19-diagnosed nonagenarians, as well as its clinical evolution and therapeutic response. METHODS: Retrospective observational study of nonagenarians, admitted for COVID-19. Sociodemographic and clinical variables were registered, including previous polypharmacy. Blood analysis data and COVID-19-specific treatment were registered. RESULTS: A total of 79 patients were included, with 50.6% (40 patients) of mortality. None of the comorbidities registered correlated with mortality, which was significantly higher among patients with moderate/complete functional dependence, compared to those mild-dependents/independents (59.5% vs 40.5%; p=0.015). Most prescribed drugs were hydroxychloroquine/chloroquine and azithromycin. Non-survivors presented higher counts of leukocytes and neutrophils, and higher lymphopenia. CONCLUSIONS: Nonagenarians with functional dependence presented higher mortality, irrespective of comorbidities or treatment received. Implementing an integral geriatric evaluation would enhance the implementation of personalized therapeutic strategies for nonagenarians.


Subject(s)
Aged, 80 and over , COVID-19/drug therapy , COVID-19/mortality , Hospitalization , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/blood , Chloroquine/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Male , Physical Functional Performance , Polypharmacy , Retrospective Studies , Risk Factors , Treatment Outcome
20.
Int J Psychiatry Med ; 56(4): 255-265, 2021 07.
Article in English | MEDLINE | ID: covidwho-1058157

ABSTRACT

BACKGROUND: There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. OBJECTIVE: We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. METHODS: We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. RESULTS: We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. CONCLUSIONS: Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.


Subject(s)
Bipolar Disorder/complications , COVID-19/complications , COVID-19/psychology , Delirium/complications , Psychotic Disorders/complications , Schizophrenia/complications , Bipolar Disorder/drug therapy , COVID-19/drug therapy , Delirium/drug therapy , Drug Interactions , Female , Humans , Male , Middle Aged , Pandemics , Polypharmacy , Psychotic Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Retrospective Studies , SARS-CoV-2 , Schizophrenia/drug therapy
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