4 Drugs Cause Most Adverse-Event Hospital Stays for Seniors

November 27, 2011

November 23, 2011 — Adverse drug events (ADEs) cause an estimated 100,000 emergency hospitalizations for seniors each year, yet two thirds involve just a handful of anticoagulants and diabetes medications, according to a study published in the November 24 issue of the New England Journal of Medicine.

The study, by researchers from the US Centers for Disease Control and Prevention (CDC), singles out 4 drugs and drug classes — warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents. Alone or together, they account for 67% of emergency ADE hospitalizations of adults 65 years and older. Warfarin was implicated in 33%, lead author Daniel Budnitz, MD, MPH, director of the CDC's Medication Safety Program, and coauthors write.

In contrast, medications red-flagged as high risk or inappropriate by health authorities explained only 1.2% and 6.6%, respectively, of such hospital admissions.

For clinicians, the take-home message of the study is clear: Improved management of antithrombotic and antidiabetes drugs can keep thousands of seniors out of the hospital.

"These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans," Dr. Budnitz said in a press release. "Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults with certain medical conditions."

"Doctors and patients should continue to use these medications but remember to work together to safely manage them."

Dr. Budnitz and coauthors analyzed data collected from 2007 to 2009 from 58 hospitals participating in an ADE surveillance project to come up with national estimates for that time frame. Nearly two thirds of the estimated 100,000 emergency ADE hospitalizations of seniors each year stemmed from unintentional overdoses, they write. In 48% of the cases, the patient was 80 years or older.

Hospitalizations arising from ADEs promise to increase "as Americans live longer, have greater numbers of chronic conditions, and take more medications," the authors note. Lowering the number of such hospitalizations, they write, is a major priority of a federal initiative called Partnership for Patients, which was launched in April.

The program aims, among other things, to reduce the number of preventable hospital readmissions by 20% by the end of 2013.

The authors have disclosed no relevant financial relationships.

N Engl J Med. 2011;365:2002-2012. Abstract

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