Correlation of Polypharmacy and Comorbidity with NIHSS Status in Ischemic Stroke Patient
Abstract
Drug-related problems are a common problem among stroke patients due to comorbidities resulting from the complex management of stroke treatment leading to polypharmacy management. Studies show that 90% of stroke patients have drug-related problems (DRPs). However, there is limited information on the impact of comorbidities as risk factors for DRP prevalence and unfavorable prognosis in patients with ischemic stroke. This study aimed to determine the risk factors for DRP and clinical outcomes as modifiable comorbidities in ischemic stroke patients admitted to a tertiary hospital between January 2020 and October 2021 were indeed significant influences. The study was conducted retrospectively using a cross-sectional analysis of patient’s medical records. The study found no significant association between the presence of comorbidities and polypharmacy in patients with the incidence of DRP, although we found that the DRPs occurrence was found more in a patient with comorbidities and polypharmacy. Diabetes mellitus was found to have a significant association with no improvement in NIHSS scores in ischemic stroke patients. We found that diabetes mellitus patient had an increased risk of non-improvement NIHSS score 2,987 times compared to patients without diabetes mellitus. The second increased risk was the presence of comorbid hypertension (OR 1.352), the third was the occurrence of polypharmacy (OR 1,175), and the fourth was dyslipidemia (OR 1.138).
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Disease. In: StatPearls. StatPearls Publishing; 2021. Accessed July 20, 2021. http://www.ncbi.nlm.nih.gov/books/NBK430927/
Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
Viswam S, Nair G, Thomas B, Shivashankar V. A Prospective Observational Study on Polypharmacy in Geriatrics at A Private Corporate Hospital. Journal of Applied Pharmaceutical Science. 2017;7:162-167. doi:10.7324/JAPS.2017.71024
Permatasari N. Perbandingan Stroke Non Hemoragik dengan Gangguan Motorik Pasien Memiliki Faktor Resiko Diabetes Melitus dan Hipertensi. Jurnal Ilmiah Kesehatan Sandi Husada. 2020;11(1):298-304.
Nahrowi NS, Ong PA, Adam A. Cognitive and Functional Outcome of Patients with Ischemic Stroke at Dr. Hasan Sadikin Hospital Bandung. Althea Medical Journal. 2018;5(2):82-86.
DiPiro JT, Yee GC, Posey M, Haines ST, Nolin TD, Ellingrod V, eds. Stroke. In: Pharmacotherapy: A Pathophysiologic Approach, 11e. 11th ed. McGraw-Hill Education; 2020:38. Accessed March 10, 2021. https://accesspharmacy.mhmedical.com/book.aspx?bookID=2577
Kose E, Maruyama R, Okazoe S, Hayashi H. Impact of Polypharmacy on the Rehabilitation Outcome of Japanese Stroke Patients in the Convalescent Rehabilitation Ward. Journal of Aging Research. 2016;2016:1-8. 5
Kanagala VS, Anusha A, Rao BS, Challa SR, Nalla KS, Gadde RS. A study of medication-related problems in stroke patients: A need for pharmaceutical care. Journal of Pharmacy Practice and Research. 2016;5(3):222-225.
Shukuri A, Tewelde T, Shaweno T. Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia. IBPC. 2019;12:23-31.
CDC. National Diabetes Statistics Report 2020. Estimates of diabetes and its burden in the United States. Published online 2020:32.
IDF. Diabetic Prevalencies : Fact and Figures. IDF : About Diabetes. Published 2021. Accessed April 1, 2022. https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html
Kemennterian Kesehatan Republik Indonesia. 2020. Tetap Produktif, Cegah dan Atasi Diabetes Mellitus. Infodatin. 2020;20(1):6.
Kementerian Kesehatan Republik Indonesia. Penyelenggaraan Pelayanan Kesehatan Lanjut Usia di Pusat Kesehatan Masyarakat. Vol 1663; 2015:7.
Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11(9):2542-2544.
Feng L, Nian S, Tong Z, et al. Age-related trends in lipid levels: a large-scale cross-sectional study of the general Chinese population. BMJ Open. 2020;10(3):e034226.
Roy-O’Reilly M, McCullough LD. Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocrinology. 2018;159(8):3120-3131.
Westberg SM, Derr SK, Weinhandl ED, et al. Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge. Journal of Pharmacy Technology. 2017;33(3):96-107.
PERKENI. Petunjuk Praktis Terapi Insulin pada Pasien Diabetes Mellitus. PB PERKENI. 2021;2:70.
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi:10.2337/dc21-S002
Garber AJ, Handelsman Y, Grunberger G, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2020 Executive Summary. Endocrine Practice. 2020;26(1):107-139.
Liu CH, Wei YC, Lin JR, et al. Initial blood pressure is associated with stroke severity and is predictive of admission cost and one-year outcome in different stroke subtypes: a SRICHS registry study. BMC Neurology. 2016;16:27.
Kemennterian Kesehatan Republik Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Stroke. Vol 342.; 2019:1-82.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12).
Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. European Stroke Journal. Published online May 11, 2021:239698732110121.
Levetan CS. Effect of hyperglycemia on stroke outcomes. Endocrine Practice. 2014;10 Suppl 2:34-39.
Mi D, Wang P, Yang B, Pu Y, Yang Z, Liu L. Correlation of hyperglycemia with mortality after acute ischemic stroke. Therapeutic Advances in Neurological Disorders. 2018;11.
Al-Weshahy A, El-Sherif R, Selim KAAW, Heikal A. Short term outcome of patients with hyperglycemia and acute stroke. The Egyptian Journal of Critical Care Medicine. 2017;5(3):93-98.
Ishitsuka K, Kamouchi M, Hata J, et al. High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes. Hypertension. 2014;63(1):54-60.
Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: A population-based study. Neurology. 2018;91(19):e1732-e1740.
Rouch L, Xia F, Bahorik A, Olgin J, Yaffe K. Atrial Fibrillation is Associated With Greater Risk of Dementia in Older Veterans. The American Journal of Geriatric Psychiatry. 2021;29(11):1092-1098.
Zhang A, Deng W, Zhang B, et al. Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease. Neurological Sciences.2021;42(6):2371-2378.
Elberta F, Ghofir A, Rusdi I. LDL/HDL ratio association with out-patient NIHSS score and Dyslipidemic Drug intake status as Metabolic Syndrome Criteria of ischemic stroke patients at RSUP Dr. Sardjito, Yogyakarta. Journal of the Medical Sciences (Berkala Ilmu Kedokteran). 2018;50(1).
Yao T, Long Q, Li J, et al. Small dense low-density lipoprotein cholesterol is strongly associated with NIHSS score and intracranial arterial calcification in acute ischemic stroke subjects. Scientific Reports.2020;10(1):7645.
Appleton SC, Abel GA, Payne RA. Cardiovascular polypharmacy is not associated with unplanned hospitalisation: evidence from a retrospective cohort study. BMC Family Practice. 2014;15:58.
von Lueder TG, Atar D. Comorbidities and polypharmacy. Heart Failure Clinics.2014;10(2):367-372.
Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Internal Medicine. 2015;175(5):827-834.
Onder G, van der Cammen TJM, Petrovic M, Somers A, Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42(3):284-291.
DOI: https://doi.org/10.15416/pcpr.v8i1.38919
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