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Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?

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Abstract

This study aimed at verifying the role of polypharmacy as an independent risk factor for adverse health outcomes in older emergency department (ED) patients. This was a large (n = 2057) sample of older ED patients (≥65 years) participating in an observational cohort study. Polypharmacy and excessive polypharmacy were defined as having 6–9 drug prescriptions and 10 or more drug prescriptions in the last 3 months, respectively. The total number of medication prescriptions was also available. Outcome measures were in-hospital mortality; 30-day ED return; ED revisit, hospital admission, and mortality at 6 months. Logistic and Cox regression models as well as receiver operating characteristic curves using the Youden index and the area under the curve were calculated. Polypharmacy and excessive polypharmacy were present in 624 (30.3 %) and 367 (17.8 %) subjects, respectively. The mean number of prescriptions in the last 3 months was 5.7 (range 0–25) drugs. Polypharmacy and, particularly, excessive polypharmacy were constantly and independently associated with worse outcomes. A cut-off of 6 had the highest value of the Youden Index in predicting the majority of the adverse outcomes considered. Polypharmacy and excessive polypharmacy are independent risk factors for adverse health outcomes after an ED visit. Further studies are needed to clarify whether drug related issues (such as non-compliance, inappropriate or suboptimal prescribing, adverse drug reactions, and drug–drug or drug–disease interactions) or underlying multimorbidity and disease severity, as well as clinical complexity and frailty, are responsible for the negative outcomes associated with polypharmacy.

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Authors and Affiliations

  1. Geriatrics and Emergency Care, IRCCS, Italian National Research Centres on Aging (INRCA), Via della Montagnola n. 81, 60127, Ancona, Italy

    Fabio Salvi & Antonio Cherubini

  2. Scientific Direction, Italian National Research Centres on Aging (INRCA), Ancona, Italy

    Lorena Rossi & Fabrizia Lattanzio

Authors
  1. Fabio Salvi
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  2. Lorena Rossi
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  3. Fabrizia Lattanzio
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  4. Antonio Cherubini
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Correspondence to Fabio Salvi.

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Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The study protocol was approved by the INRCA Ethics Committee (Ancona, Italy). Each participant gave Informed consent to participate to the study.

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Salvi, F., Rossi, L., Lattanzio, F. et al. Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?. Intern Emerg Med 12, 213–220 (2017). https://doi.org/10.1007/s11739-016-1451-5

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