Associate Professor The Ohio State University The Ohio State university Columbus, United States
Background: Anticoagulants, antidiabetic agents and opioids are frequently prescribed among older adults and account for ~60% of emergency department (ED) visits due to adverse drug events (ADEs). Polypharmacy involving these drugs is common and could further increase the risks of serious ADEs among older adults. The risk factors of concurrent use of multiple drugs and anticoagulants, antidiabetic agents and opioids are not well known.
Objectives: To assess the risk factors of exposure to high-risk 3-drug combinations involving at least an anticoagulant, antidiabetic agent or opioid among older adults in ED settings.
Methods: A cohort of older adults (≥65 years) who visited an ED were identified from the MarketScan Medicare Supplemental dataset. A cross-sectional study design was implemented. The outcome was defined as exposure to concurrent use of high-risk 3-drug combinations involving at least an anticoagulant, antidiabetic agent or opioid within a 30-day risk window prior to the ED visit date; the top 10% of 3-brug combinations with the highest proportion of ADEs during an ED visit were considered as high-risk 3-drug combinations. Concurrent exposure to all 3-drug combinations was operationalized based on overlap of prescription fill dates and the day’s supply filled medications within the risk window, thus patients were required to be continuously enrolled for ≥30 days prior to the ED visit date. The fill date of the drug that was initiated first among the 3-drug combination was set as the index date for measuring potential predictors including a set of demographic, comorbidities, comedication use and healthcare utilization factors. Logistic regression models were used to identify the independent predictors of exposure to these high-risk 3-drug combinations.
Results: Of the 78011 patients who were exposed to 3-drug combinations involving at least an anticoagulant, 2% were considered to be exposed to high-risk combinations. Exposure to high-risk drug combinations were rare among patients who used 3-drug combinations involving at least one opioid (0.5%) and at least one antidiabetic agent (0.2%). Thus, we present results on the anticoagulant analytic dataset. Coronary artery disease, asthma, hypertension, diabetes and comorbidity score were the chronic condition factors associated with higher odds of exposure to high-risk 3-drug combinations. For concurrent drug use, beta-blockers, ARBs, calcium-channel blockers and diuretics were associated with higher odds of exposure to high-risk 3-drug combinations.
Conclusions: Exposure to high-risk 3-drug combinations involving at least an anticoagulant, antidiabetic agent and opioid were very low in this population.
