Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med. 2007;147(11):755-765

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Annals of internal medicine (Impact Factor: 17.81). 01/2008; 147(11):755-65.
Source: PubMed


The Beers criteria identify inappropriate use of medications in older adults. The number of and risk for adverse events from these medications are unknown.
To estimate the number of and risk for emergency department visits for adverse events involving Beers criteria medications compared with other medications.
Nationally representative, public health surveillance of adverse drug events and a cross-sectional survey of outpatient medical visits.
National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance System, 2004-2005; National Ambulatory Medical Care Survey, 2004; and National Hospital Ambulatory Medical Care Survey, 2004.
Persons 65 years of age or older seeking emergency department and outpatient care.
Estimated number of and risks for emergency department visits for adverse drug events involving Beers criteria medications and other medications.
Among U.S. patients 65 years of age or older, an estimated 177,504 emergency department visits (95% CI, 100,155 to 254,854 visits) for adverse drug events occurred both years. An estimated 3.6% (CI, 2.8% to 4.5%) of these visits were for adverse events medications considered to be always potentially inappropriate, according to the Beers criteria, and 33.3% (CI, 27.8% to 38.7%) of visits were for adverse events from 3 other medications (warfarin [17.3%], insulin [13.0%], and digoxin [3.2%]). Accounting for outpatient prescription frequency, the risk for emergency department visits for adverse events due to these 3 medications was 35 times (CI, 9.6 to 61) greater than that for medications considered to be always potentially inappropriate.
Adverse events were identified only in emergency departments.
Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.

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Available from: Budnitz Daniel, Jan 30, 2014
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    • "The narrow therapeutic range of warfarin dosage may increase the risk of recurrence of thromboembolism and bleeding [1], so it is difficult to establish the appropriate dose of warfarin to achieve anticoagulation. Over time, many factors have proven to be associated with therapeutic warfarin dose requirements, including basic elements such as gender, age, weight, and body surface area [2] [3] [4]; however, these elements do not explain all of the differences that currently exist among warfarin dose requirements among different individuals and different ethnicities. "
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    ABSTRACT: Background: The Gamma-glutamyl carboxylase (GGCX) gene, as with Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1), CytochromeP450 Complex Subunit 14 F2 (CYP4F2) and CytochromeP450 Complex Subunit2C9 (CYP2C9), is a candidate predictor for appropriate maintenance warfarin dose. However, the association between GGCX gene polymorphisms and warfarin dose requirement is still controversial. To quantify the influence of GGCX polymorphisms on warfarin dose requirements, we performed a systematic review and meta-analysis. Methods: According to PRISRM statement (Preferred reporting items for systematic reviews and meta-analyses), a comprehensive literature search was undertaken through August 2014 looking for eligible studies in Embase, Pubmed,Web of Science and the Cochrane Library. The impact of GGCX polymorphisms on mean daily warfarin dose (MDWD) was counted by means of Z test. RevMan 5.2.7 software (developed by the Cochrane Collaboration) was applied to analyze the relationship between GGCX gene polymorphisms and warfarin dose requirements. Results: Nineteen articles including 21 studies with a total of 6957 patients were included in the meta-analysis. Among three investigated single nucleotide polymorphisms (SNPs), rs11676382 showed higher CC genotype frequencies in Asian than those in Caucasian (97.7% vs. 86.9%); patients who were "G carriers" (that is, carried the GGCX rs11676382 CG or GG genotypes) required 27% lower warfarin dose than CC genotype [95%Confidence Interval (CI)=17%-37%, P=0.000, I(2)%=82.0 and PQ=0.000], moreover, stratified analysis by ethnicity showed similar results in Caucasian (23% lower, 95%CI=12%-33%), but not in Asian. With respect to genetic variation of rs699664 and rs121714145 SNPs, no significant impact on warfarin dose requirements were demonstrated. Conclusions: This meta-analysis suggested that GGCX rs11676382 polymorphism may be one of factors affecting the dose of warfarin requirement, and the effects are different in different ethnicities. Further studies about this topic in different ethnicities with larger samples are expected to be conducted to validate our results.
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    • "In general, older patients may require multiple medications, and thus are more likely to receive PIMs which are associated with an increased rate of ADEs [9] [33]. In our study, 6.8% (20/295) of ADEs met the Beers criteria [34] (a consensus-based list of medication identified as potentially inappropriate for use in older adults), which was lower than the 8.8% reported in a U.S. crosssectional study [35]. The discrepancy can be due to differences in the study design, sample size, and identification of ADE cases. "
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    ABSTRACT: Little is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits. We prospectively conducted a case-control study of patients 65years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression. Of 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR]=4.1; 95% confidence interval [CI] 2.4-6.9 for 3-7 drugs; adjusted OR=6.4; 95% CI 3.7-11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR=1.5; 95% CI 1.1-2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits. This study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents.
    Full-text · Article · Nov 2013 · European Journal of Internal Medicine
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