Abstract

Introduction: The polypharmacy is common in ambulatory care, hospital and nursing home patients. Over the last 20-30 years, problems related to aging, multi morbidity, and polypharmacy have become a prominent issue in global healthcare. In the developed countries around 3-4% of the people could be identified as chronic complex patient and they are increasingly at risk of polypharmacy. The main objective of this study we as to evaluate the association of polypharmacy and mortality risk.

Materials and Methods: We carried out a multicenter and prospective cohort study of mortality incidence from 01.01.2013 to 30.09.2016 among 825 adult patients registered in the electronic health record of Primary Care as Chronic Complex Outpatient. To predict hazard ratios, mean survival time, and survival probabilities used a multivariate Cox regression.

Results: 932 CCP cases were included (52.3% women). Average age was 82.5 yr (CI95% 81.8-83.2). 91.6% CCP had ≥4 and the 42.9% CCP had ≥10 active medication. The mean number of medications used by participants was 9.0±3.6 daily medications. Proton pump inhibitors (68.5%), statins (45.5%), hypnotics (45.3%), anti aggreggants (41.5%) and SSRIs (30.1%) were the most commonly used medications. The patients with fall risk or Barthel score <60 associated to polypharmacy ≥10 active medications had higher mortality. We observed a strong association that persisted even after adjustment for known mortality risk factors: age [HR 1.04 CI95 1.02-1.05, p < 0.001], Charlson score [HR 1.21 CI95 1.12-1.30, p<0.001] and Barthel [HR 0.988 CI95 0,985-0.992, p<0.001].

Conclusion: This study confirms the polypharmacy (≥ 10) was associated with increased risk of mortality if there was associated risk of falling or functional disability (Barthel score<60) and they are a useful indicator to identify subjects eligible for preventive measures in public health strategies.

Keywords: Falls; Chronic complex patient; Mortality; Polypharmacy; Fall risk; Disability.

Abbreviations: CCP: Chronic and Complex Patient; HR: Hazard Risk; IDIAP: Primary Care Research Institute Jordi Gol I Gurina; PIIC: Shared Individual Intervention Plan [Pla d’intervenció individualitzat compartit (PIIC)]; SD: Standart Deviation; SSRI: Serotonin Reuptake Inhibitor; TTR: Time in Therapeutic Range