!Polypharmacy!in!Stable!Elderly!Medical!Pa5ents!is!Prevalent!but!Virtually!
Unaddressed!by!Emergency!Physicians:!No!Apparent!Link!to!Six!Month!Mortality!!
Camilla!Strøm,!Søren!Wis5sen!Rasmussen,!Thomas!Andersen!Schmidt!!Department!of!Emergency!Medicine,!Holbaek!Sygehus,!Copenhagen!University!Hospital,!Denmark!
Introduc5on!&!Scope!Adversely!impac/ng!elderly!pa/ents,!polypharmacy!may!not!be!addressed!in!the!Emergency!Department!se9ng!(ED).!The!SCOPE!of!the!study!was!to!observe!whether!emergency!physicians!addressed!polypharmacy,!and!to!observe!whether!there!were!subsequent!differences!in!hard!endpoints.!
Polypharmacy!is!defined!as!the!use!!≥!5!medica5ons!per!day.!
Methods!Retrospec/ve!chart!review.!Over!the!dura/on!of!1!month!consecu/ve!stable!pa/ents!≥75!years!old!admiEed!to!the!ED!were!divided!into!a!polypharmacy!group!(PGgroup)!taking!≥!5!drugs!and!a!non!polypharmacy!group!(NPWgroup)!taking!less!than!5!drugs!per!day.!!We!registered!in!how!many!pa/ents,!polypharmacy!had!been!addressed!by!the!admi9ng!physicians!in!the!pa/ents’!charts.!The!two!groups!were!compared!with!regard!to!• 6Gmonth!mortality!• length!of!stay!(LOS)!• inGhospital!mortality!• transfer!of!care!• adverse!events!• number!of!readmissions!Results!are!reported!by!number!(%),!mean!(SD)!or!median!(IQR).!We!used!Chi!squareGtest,!unpaired!Student`s!tGtest!or!mul/ple!logis/c!regression!analysis!as!appropriate.!!
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KEY!FINDINGS!
NP!n=32!(20%)!
P!n=125!(80%)! !!!!p!
Age!in!years,!mean!(SD)! 83.8!(6.1)! 83.0!(6.0)! 0.50!
Gender!female/male,!n!(%)! 16/16!(50/50)! 58/67!(46/54)! 0.72!
Median!number!of!daily!medica/ons,!n!(IQR)! 3!(2G5)! 9!(7G11)! NA!
Pa%ents!where!polypharmacy!has!been!addressed!in!ED! 8!(6)!
6!month!mortality,!n!(%)! 6!(19)! 19!(15)! 0.83!
LOS!in!days,!median!(IQR)! 5.25!(1.2G7.2)! 7.4!(1.9G11.4)! 0.10!
Pa/ents!with!one!or!more!adverse!events,!n!(%)! 5!(16)! !11!(9)! 0.41!NP:!non!polypharmacy.!P:!polypharmacy.!p:!pGvalue!Adverse!events:!nosocomial!infec/on,!medica/on!error,!deep!venous!thrombosis,!pulmonary!embolism,!delirium,!falls,!fractures,!decubitus!ulcers,!GI!haemorrhage,!cerebral!infarc/on.!
Conclusion!• The!prevalence!of!polypharmacy!was!high!(80%)!• ED!physicians!address!polypharmacy!to!a!very!limited!extent!
(6%).!!• Polypharmacy!did!not!have!an!apparent!impact!on!6Gmonth!
mortality,!LOS,!inGhospital!mortality,!transfer!of!care,!adverse!events,!or!the!number!of!readmissions.!!
• This!study!is!limited!due!to!small!sample!size!and!retrospec/ve!design!
• A!randomised!clinical!trial!is!pending!!!
