Citation

Hélias G, Garnier V, Enzinger L, Eymaron M, Ageron FX, Couturier P. Geriatr. Psychol. Neuropsychiatr. Vieil. 2023; 21(2): 173-184.

Vernacular Title

Étude de l'exposition médicamenteuse aux cardiotropes des sujets âgés consultant aux urgences pour chute avec malaise en Rhône-Alpes

Copyright

(Copyright © 2023, John Libbey Eurotext)

DOI

10.1684/pnv.2023.1107

PMID

37519075

Abstract

Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region. Polypharmacy and cardiovascular medication usage are risk factors for falls in the elderly. This study included subjects aged 75 and over, admitted in the emergency department for falls, based on evaluation data of professional practices carried out in the Nord Alpine region by the French Network of North-Alps Emergency Departments (Réseau Nord Alpin des Urgences, RENAU). The patients included were divided into 4 groups: "syncope", "accidental falls", "repeated falls" and "other types of fall". From the emergency room admission prescriptions, we studied the consumption of cardiovascular drugs in number and quality in the "syncope" group compared to other types of falls. The main objective in this study was to highlight higher cardiovascular drug usage among the elderly patients admitted to the emergency department for syncopal falls, in comparison with other types of falls. We included 1,476 patients among whom 262 patients came for "syncopal falls". We found superior usage of cardiovascular medication among syncopal falls compared to other type of falls (p < 0,01). However, there is no statistically significant association between inappropriate cardiovascular drug prescriptions, and the type of falls. The "standardized" fall assessment whose orthostatic hypotension investigation, is not always exhaustive in the emergency room. Orthostatic hypotension diagnostic is insufficiently sought in the emergency room. This study highlights a significantly higher usage of diuretic medication within the syncope group, in comparison to the other groups, and especially loop diuretic. Antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, calcium inhibitor) are also recurrent within the syncope group compared to the others. A careful supervising of these prescriptions among elderly patients seems required. These data prompt to revise prescriptions during fall related hospitalizations, and then with the primary-care physician, or with the cardiologist.

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La polymédication et l'usage de cardiotropes sont des facteurs de risque de chute chez le sujet âgé. Cette étude a inclus des sujets de 75 ans et plus, vivant à domicile et admis aux urgences pour une chute à partir de données d'une précédente étude en Rhône-Alpes. Les ordonnances répertoriées à l'admission ont permis d'étudier la consommation de cardiotropes ainsi que les prescriptions médicamenteuses inappropriées, définies selon la Haute Autorité de santé. L'objectif est de montrer une exposition aux cardiotropes accrue chez les patients âgés consultants aux urgences pour chute avec malaise par rapport aux autres mécanismes de chutes. Notre étude a inclus 1 476 patients dont 262 chutes avec malaises. En moyenne, les patients avaient 2,04 médicaments cardiotropes. Il existe une surexposition aux cardiotropes dans le groupe " malaise " en comparaison aux autres causes de chute (p < 0,01). Il n'y a pas de lien statistiquement significatif entre les prescriptions inappropriées de cardiotropes et le type de chutes. Le groupe " malaise " a un usage significativement plus élevé de médicaments diurétiques par rapport aux autres groupes dont les diurétiques de l'anse. La révision d'ordonnances après une chute est indispensable chez le sujet âgé et justifie d'une consultation précoce auprès du médecin traitant ou du cardiologue.

Language: fr

Keywords

Aged; Humans; Accidental Falls; Hospitalization; falls; Emergency Service, Hospital; emergency; *Cardiovascular Agents/adverse effects; *Hypotension, Orthostatic/complications/diagnosis; cardiovascular medications exposure; elderly patient; syncope; Syncope/epidemiology