Warren's World: Adverse Drug Events Are Common Just After Hospitalization

From Journal Watch (NEJM):

January 9, 2014

Adverse Drug Events Are Common Just After Hospitalization

Allan S. Brett, MD reviewing Kanaan AO et al. J Am Geriatr Soc 2013 Nov.

One in five older adults experienced an adverse drug event after hospital discharge.

Discussion of adverse drug events (ADEs) in older adults often focuses on Beers-criteria medications that are considered to be “potentially inappropriate” for anyone in this age group; drugs with adverse central nervous system effects, nonsteroidal anti-inflammatory drugs, and several cardiovascular drugs dominate the Beers list (J Am Geriatr Soc 2012; 60:616). In this study of 1000 consecutive hospitalized patients (age, ≥65), researchers focused specifically on ADEs that occurred during the 6 weeks after hospital discharge. All patients lived in the community (not in long-term care facilities).

At least one ADE occurred in 19% of cases. One quarter of ADEs were considered to be serious or life-threatening, and one third were considered to be preventable. The most common types of ADEs were gastrointestinal, renal-electrolyte, and cardiovascular; the most commonly implicated drug classes were cardiovascular drugs, diuretics, opioids, antithrombotic agents, and antibiotics. Only 17% of implicated drugs carried a “strong” recommendation for avoidance on the Beers list.

COMMENT

Do we need yet another reminder about the hazards of drug prescribing in older patients? In my view, the answer is yes: This study highlights the vulnerable immediate posthospitalization period, when patients are exposed to newly prescribed drugs just following acute illness. Moreover, the study reminds us that just about any drug class (not just drugs on the Beers list) is potentially hazardous.

 Editor Disclosures at Time of Publication

CITATION(S):

1. Kanaan AO et al. Adverse drug events after hospital discharge in older adults: Types, severity, and involvement of Beers criteria medications. J Am Geriatr Soc 2013 Nov; 61:1894. (http://dx.doi.org/10.1111/jgs.12504)

   
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READER COMMENTS (2)

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Dr. V Kantariya MD Physician, Family Medicine/General Practice

10 Jan 2014 12:26 PM

The Beers, STOPP, and START criteria can help identify medication causing ADE. Clinicians should involve patients in shared decision, making an individualized prescribing decision. .What if the Doctor Is Wrong? Getting a Second Opinion!

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Len Saputo, MD Physician, Internal Medicine, Health Medicine Center

10 Jan 2014 4:52 AM

The medical profession is so oriented to relying on drugs, surgery, and technologies that we forget about alternative approaches to managing the symptoms of our patients. We have limited or no training, and little interest in solutions that involve chiropractic, acupuncture, herbal and other nutritional therapies, light therapies, etc that have considerable value. When there are at least 400,000 deaths and more than 2 million hospitalizations annually in the US from the use and misuse of medications, it is time to learn more about some of the above strategies!

- See more at: http://www.jwatch.org/na33302/2014/01/09/adverse-drug-events-are-common-just-after-hospitalization?query=etoc_jwgenmed#sthash.ttYan0d7.dpuf