Excessive polypharmacy and survival in polypathological patients.
OBJECTIVE
The purpose of this study was to determine whether excessive polypharmacy is associated with a higher survival rate in polypathological patients.


METHODS
An observational, prospective, and multicenter study was carried out on those polypathological patients admitted to the internal medicine and acute geriatrics departments between March 1 and June 30, 2011. For each patient, data concerning age, sex, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer's questionnaire, socio-familial Gijon scale, delirium, number of drugs, and number of admissions during the previous year were gathered, and the PROFUND index was calculated. Polypharmacy was defined as the use of ≥ 5 drugs and excessive polypharmacy as the use of ≥ 10. A 1-year long follow-up was carried out. A logistic regression model was performed to analyze the association of variables with excessive polypharmacy and a Cox proportional hazard model to determine the association between polypharmacy and survival.


RESULTS
We included 457 polypathological patients. Mean age was 81.0 (8.8) years and 54.5% were women. The mean number of drugs used was 8.2 (3.4). Excessive polypharmacy was directly associated with heart disease [hazard ratio (HR) 2.33 95% CI 1.40-3.87; p =0.001], respiratory disease [HR 1.87 95% CI 1.13-3.09; p = 0.01], peripheral artery disease/diabetes with retinopathy and/or neuropathy [HR 2.02 95% CI 1.17-3.50; p = 0.01], and the number of admissions during the previous year [HR 1.21 96%CI 1.01-1.44; p = 0.04]. It was inversely associated with delirium [HR 0.48 95% CI 0.25-0.91; p = 0.02]. There were no statistical differences regarding the probability of 1-year survival between patients with no polypharmacy, with simple polypharmacy, and with excessive polypharmacy (0.66, 0.60, and 0.57, respectively, p = 0.12).


CONCLUSIONS
A greater use of drugs may not be harmful but is also not associated with a higher probability of survival in polypathological patients.
Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain. jdiez@aragon.es.|Comorbidity and Polypathology in Aragón Research Group, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. jdiez@aragon.es.|Departamento de Medicina, Dermatología y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain. jdiez@aragon.es.|, Duquesa Villahermosa n° 163, 8° D, 50009, Zaragoza, Spain. jdiez@aragon.es.
Jesús
http://orcid.org/0000-0002-3132-2171
J
Díez-Manglano
Geriatrics Department, Hospital San Juan de Dios, Zaragoza, Spain.
Mercedes
M
Giménez-López
Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain.
Vanesa
V
Garcés-Horna
Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain.
María
M
Sevil-Puras
Internal Medicine Department, Hospital de Barbastro, Huesca, Spain.
Elena
E
Castellar-Otín
Geriatrics Department, Hospital San José, Teruel, Spain.
Paloma
P
González-García
Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Spain.
Isabel
I
Fiteni-Mera
Geriatrics Department, Hospital Nuestra Señora de Gracia, Zaragoza, Spain.
Teresa
T
Morlanes-Navarro
D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine; D016015:Logistic Models; D008297:Male; D019338:Polypharmacy; D055553:Prescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D055553:Prescription Drugs