Multimorbidity and medication complexity: New challenges in heart transplantation
Por:
Gomis-Pastor, M, Mingell, ER, Perez, SM, Loidi, VB, Lopez, LL, Bassons, AD, Pousa, AA, Ribera, AF, Ferrero-Gregori, A, Perich, LG, Bafalluy, MAM
Publicada:
1 oct 2019
Ahead of Print:
1 ago 2019
Resumen:
Introduction Multimorbidity and therapeutic complexity are a recognized problem in the heart transplant (HTx) population. However, little is known about how best to quantify this complexity or the strategies that could reduce its burden. Methods This single-center, observational study included adult heart transplant recipients (HTxR) >1.5 years from transplant. We assessed multimorbidity (>2 comorbidities) and the patient-level Medication Regimen Complexity Index Spanish version (pMRCI-S) score. We also analyzed the independent predictors of pMRCI-S and the impact of the index score on specific clinical variables. Results We included 135 chronic-stage HTxR. Comorbidities significantly increased after HTx (6 +/- 3 vs 2 +/- 2, P-value < .001). Patients took 12 +/- 3 chronic drugs/d, 58% of them to treat comorbidities. The mean total pMRCI-S score was 42 +/- 11, higher than in several other chronic diseases. The medication category drugs to treat comorbidities predicted a higher total pMRCI-S score (OR = 3.12, 95% CI 2.8-3.43, P-value < .001). Therapeutic complexity after HTx had an impact on solid malignancies (OR = 1.1, 95% CI 1.02-1.18, P-value = .02) and renal function (OR=-0.81, 95% CI -1.21-(-0.42), P-value < .001). Conclusions The multimorbidity and pMRCI-S scores obtained in HTx population were worrisomely high. The pMRCI score is a sensitive method that allows identification of the factors determining therapeutic complexity after HTx and selection of strategies to reduce pMRCI-S values.
Filiaciones:
Gomis-Pastor, M:
Hosp Santa Creu & Sant Pau, Heart Transplant Unit, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona, Spain
Autonomous Univ Barcelona UAB, Barcelona, Spain
Mingell, ER:
Autonomous Univ Barcelona UAB, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Dept Cardiol, Heart Failure & Heart Transplant Unit, Barcelona, Spain
Perez, SM:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Heart Failure & Heart Transplant Unit, Barcelona, Spain
Loidi, VB:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Heart Failure & Heart Transplant Unit, Barcelona, Spain
Lopez, LL:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Heart Failure & Heart Transplant Unit, Barcelona, Spain
Bassons, AD:
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona, Spain
Pousa, AA:
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona, Spain
Ribera, AF:
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona, Spain
Ferrero-Gregori, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Biomed Res IIB St Pau, Dept Cardiol,CIBERCV, Barcelona, Spain
Perich, LG:
Autonomous Univ Barcelona UAB, Barcelona, Spain
Fundacio Puigvert, Dept Nephrol, Barcelona, Spain
Fundacio Puigvert, Dept Nephrol, Renal Transplant Unit, Barcelona, Spain
Bafalluy, MAM:
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona, Spain
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