Abstract
Aim: The aim of the study was to investigate whether multimorbidities, comorbidities, and therefore polypharmacy increase with age in hemophilia A and B patients followed in Ege University Adult Hemophilia and Thrombosis Center.
Materials and Methods: Adult hemophilia A and B patients were retrospectively evaluated. Patients'demographic data, medical information about hemophilic arthropathy, viral infections hepatitis C virus (HCV), body mass index (BMI), smoking and alcohol consumption, concomitant diseases, and all medications except factor replacement therapy were analyzed. Polypharmacy was defined as ≥5 drug use. Patients were compared by dividing into two groups: ≤55 years and >55 years.
Results: A total of 230 patients were evaluated (189 hemophilia A, 41 hemophilia B). There were 191 patients in ≤55 years (83%), and 39 patients in >55 years age groups (17%). The most common diseases in hemophilia patients were hypertension (19.5%), diabetes mellitus (10%), and gastroesophageal reflux disease-chronic gastritis (5.2%). The most common drugs that patients use
regularly were non-steroidal anti-inflammatory drugs (14.3%), proton pump inhibitors (12.1%), and oral antidiabetics (9.5%). The number of diseases not related to hemophilia (multimorbidity) and
polypharmacy in hemophilia patients aged >55 years was significantly higher than those aged <55 years (p values were 0.00 and 0.01 respectively). There was no difference between the groups in BMI, alcohol and cigarette use, and the history of HCV infection.
Conclusion: Our study showed that aging hemophilia patients have more multimorbidities and use more drugs than younger patients. For this reason, the importance of the effects of additional diseases and drugs on quality of life, treatment compliance, and hemostasis is increasing.
Keywords
References
- Hermans C, de Moerloose P, Dolan G. Clinical management of older persons with haemophilia. Crit Rev Oncol Hematol 2014; 89: 197-206.
- Riva S, Mancuso ME, Cortesi L, et al. Polypharmacy in older adults with severe haemophilia. Haemophilia 2018; 24: e1-e3.
- Riva S, Nobili A, Djade CD, Mancuso ME, Santagostino E, Pravettoni G. Cognitive and psychological profiles in treatment compliance: a study in an elderly population with hemophilia. Clin Interv Aging 2015; 10: 1141-6.
- Grumbach K. Chronic illness, comorbidities, and the need for medical generalism. Ann Fam Med 2003; 1: 4–7.
- Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17: 230.
- Mannucci PM, Iacobelli M. Progress in the contemporary management of hemophilia: The new issue of patient aging. Eur J Intern Med 2017; 43: 16-21.
- Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc 2012; 60: 34-41.
- Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf 2011 May; 20: 514-22.
- Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 2004; 38: 303–12.
- Mannucci PM, Nobili A, Pasina L; REPOSI Collaborators (REPOSI is the acronym of REgistro POliterapie SIMI, Società Italiana di Medicina Interna). Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13: 1191-200.
- Mannucci PM, Nobili A, Marchesini E, et al. Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls. Haemophilia 2018; 24: 726-32.
- Sood SL, Cheng D, Ragni M, et al. A cross-sectional analysis of cardiovascular disease in the hemophilia population. Blood Adv 2018; 2: 1325-33.
- Mannucci PM, Schutgens RE, Santagostino E, Mauser-Bunschoten EP. How I treat age-related morbidities in elderly persons with hemophilia. Blood 2009; 114:5256-63.
- Mannucci PM. Aging with Hemophilia: The Challenge of Appropriate Drug Prescription. Mediterr J Hematol Infect Dis 2019; 11: e2019056.
Abstract
Amaç: Çalışmamızın amacı Ege Üniversitesi Erişkin Hemofili ve Tromboz Merkezi'nde takip edilen hemofili A ve B hastalarında yaşla birlikte multimorbidite, komorbidite ve dolayısıyla polifarmasi artışı olup olmadığını araştırmaktır.
Gereç ve Yöntem: Takip edilen erişkin hemofili A ve B hastaları geriye dönük olarak değerlendirildi. Hastaların demografik verileri, hemofilik artropati, hepatit C virüsü (HCV) ile ilgili tıbbi bilgileri, vücut kitle indeksi (VKİ), sigara ve alkol kullanımı, eşlik eden hastalıkları ve faktör replasman tedavisi dışındaki tüm ilaçları incelendi. Polifarmasi, ≥5 ilaç kullanımı olarak tanımlandı. Hastalar ≤55 yaş ve >55 yaş olarak iki gruba ayrılarak karşılaştırıldı.
Bulgular: Toplam 230 hasta değerlendirildi (189 hemofili A, 41 hemofili B). ≤55 yaş grubunda (%83) 191 hasta ve >55 yaş grubunda (%17) 39 hasta vardı. Hemofili hastalarında en sık görülen hastalıklar hipertansiyon (%19,5), diabetes mellitus (%10) ve gastroözofageal reflü hastalığı-kronik gastrit (%5,2) idi. Hastaların en sık kullandıkları ilaçlar nonsteroid antiinflamatuar ilaçlar (%14,3), proton pompa inhibitörleri (%12,1) ve oral antidiyabetiklerdi (%9,5). 55 yaş üzeri hastalarda hemofili ile ilişkili olmayan hastalıklar (multimorbidite) ve polifarmasi <55 yaş grubuna göre anlamlı olarak daha fazlaydı (sırasıyla p değerleri 0.00 ve 0.01).Gruplar arasında VKİ, alkol ve sigara kullanımı ve HCV enfeksiyon öyküsü açısından fark yoktu.
Sonuç: Çalışmamız, yaşlanan hemofili hastalarının genç hastalara göre daha fazla multimorbiditeye sahip olduğunu ve daha fazla ilaç kullandığını göstermiştir. Bu nedenle ek hastalık ve ilaçların yaşam kalitesi, tedaviye uyum ve hemostaz üzerindeki etkilerinin önemi giderek artmaktadır.
Keywords
References
- Hermans C, de Moerloose P, Dolan G. Clinical management of older persons with haemophilia. Crit Rev Oncol Hematol 2014; 89: 197-206.
- Riva S, Mancuso ME, Cortesi L, et al. Polypharmacy in older adults with severe haemophilia. Haemophilia 2018; 24: e1-e3.
- Riva S, Nobili A, Djade CD, Mancuso ME, Santagostino E, Pravettoni G. Cognitive and psychological profiles in treatment compliance: a study in an elderly population with hemophilia. Clin Interv Aging 2015; 10: 1141-6.
- Grumbach K. Chronic illness, comorbidities, and the need for medical generalism. Ann Fam Med 2003; 1: 4–7.
- Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17: 230.
- Mannucci PM, Iacobelli M. Progress in the contemporary management of hemophilia: The new issue of patient aging. Eur J Intern Med 2017; 43: 16-21.
- Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc 2012; 60: 34-41.
- Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf 2011 May; 20: 514-22.
- Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 2004; 38: 303–12.
- Mannucci PM, Nobili A, Pasina L; REPOSI Collaborators (REPOSI is the acronym of REgistro POliterapie SIMI, Società Italiana di Medicina Interna). Polypharmacy in older people: lessons from 10 years of experience with the REPOSI register. Intern Emerg Med 2018; 13: 1191-200.
- Mannucci PM, Nobili A, Marchesini E, et al. Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls. Haemophilia 2018; 24: 726-32.
- Sood SL, Cheng D, Ragni M, et al. A cross-sectional analysis of cardiovascular disease in the hemophilia population. Blood Adv 2018; 2: 1325-33.
- Mannucci PM, Schutgens RE, Santagostino E, Mauser-Bunschoten EP. How I treat age-related morbidities in elderly persons with hemophilia. Blood 2009; 114:5256-63.
- Mannucci PM. Aging with Hemophilia: The Challenge of Appropriate Drug Prescription. Mediterr J Hematol Infect Dis 2019; 11: e2019056.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 15, 2023 |
| Submission Date | March 18, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 1 |
