title: Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission.
abstract: OBJECTIVE
  Adverse drug events (ADEs) lead to adverse clinical outcomes such as hospitalization. There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy. This study aimed to evaluate (i) the prevalence of ADEs at the time of admission to hospital, (ii) the causality, severity, and preventability of the ADEs, and (iii) the clinical and pharmacological characteristics associated with the ADEs.
  
  
  METHODS
  This is a prospective cross-sectional study (county of Osona, Catalonia, Spain). We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit (AGU). A system of alerts (trigger tool) was used together with a multidisciplinary review for the detection of the ADEs.
  
  
  RESULTS
  Over the course of 10 months, 235 patients were recruited. Seventy-six ADEs affecting 24.68 % of the sample were identified, and of these, 23 (30.26 % of the ADEs; 8.51 % of the sample) were directly related to hospitalization. The multivariate logistic regression analysis identified the following risk factors: presence of extreme polypharmacy (≥10 medications) (OR = 3.02; 95 % CI = 1.48-6.19), anticholinergic burden according to the Anticholinergic Drug Scale (ADS) (OR = 2.32; 95 % CI = 1.13-4.78), and treatment complexity according to the Medication Regimen Complexity Index (MRCI) scale (OR = 2.90; 95 % CI = 1.44-5.83). The vast majority (94.45 %) of the ADEs were considered to be preventable. There were no differences in the survival of the patients.
  
  
  CONCLUSIONS
  ADEs are common, largely preventable, and implicated in the hospitalization of patients who require palliative care.
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain. danielsevillasanchez@gmail.com.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0003-2993-6200
authors.initials: D
authors.lastname: Sevilla-Sanchez
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Molist-Brunet
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Amblàs-Novellas
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Roura-Poch
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Espaulella-Panicot
authors.affiliation: Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Codina-Jané
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002908:Chronic Disease / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing; D008017:Life Expectancy; D008297:Male; D010166:Palliative Care; D019338:Polypharmacy; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D018680:Cholinergic Antagonists
keywords: Adverse drug events; Chronic disease; End-of-life; Hospital admission; Palliative care; Polypharmacy