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Warfarin, diabetes medications implicated in emergency hospitalization among elderly
Budnitz DS. N Engl J Med. 2011;365:2002-2012.
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Nearly 70% of emergency hospitalizations for adverse drug events in the United States among adults aged at least 65 years were attributed to the use of warfarin, insulins, oral antiplatelet agents and oral hypoglycemic agents alone or in combination, according to data published in The New England Journal of Medicine.
“[T]he finding that more than 66,000 emergency hospitalizations were for adverse effects of a few, commonly prescribed antithrombotic and antidiabetic agents has important implications for efforts to reduce harm to patients and to reduce health care costs,” the researchers wrote.
Using data from the National Electronic Injury Surveillance System — Cooperative Adverse Drug Event Surveillance project, conducted from 2007 to 2009, researchers calculated hospitalization rates and frequency after ED visits for adverse drug events among adults aged at least 65 years. Researchers aimed to determine whether specific medications — both high-risk and potentially inappropriate — contributed to these rates. A total of 12,666 cases were identified.
Each year, an estimated 265,802 ED visits due to adverse drug events occurred among those aged at least 65 years (95% CI, 184,040-347,563), 37.5% of which required hospitalization. Hospitalization of adults aged at least 80 years accounted for nearly half of all those reported (48.1%; 95% CI, 44.6-51.6). Visits requiring hospitalization were more likely due to unintentional overdoses (65.7%) vs. those visits not requiring hospitalization (45.7%). In addition, those resulting in hospitalization involved five or more concomitant medications (54.8%) vs. those not resulting in hospitalization (39.9%).
The most commonly implicated medications were: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%) and oral hypoglycemic agents (10.7%). When stratified across age and sex, these four drugs remained most frequently involved.
High-risk and potentially inappropriate medications were implicated in 1.2% and 6.6% of hospitalizations, respectively.
“Our findings suggest that efforts to improve medication safety for older adults should focus on areas in which improvements are most likely to have sizeable, clinically significant, and measureable effects, such as improving the management of antithrombotic and antidiabetic drugs,” the researchers wrote.
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