JAMDA
Volume 11, Issue 7 , Pages 475-484 , September 2010

An Analysis of the Interactions Between Individual Comorbidities and Their Treatments—Implications for Guidelines and Polypharmacy

  • Stephen P. Fitzgerald, MB, BS, FRACP

      Affiliations

    • Internal Medicine, Royal Adelaide Hospital, Australia
    • Corresponding Author InformationAddress correspondence to Stephen P. Fitzgerald, FRACP, BSc, Internal Medicine, Royal Adelaide Hospital, SA 5000, Australia.
  • ,
  • Nigel G. Bean, BSc, PhD

      Affiliations

    • Applied Mathematics, University of Adelaide, Australia

References 

  1. Hilmer NH. The dilemma of polypharmacy. Aust Prescr. 2009;31:2–3
  2. Tonkin AM, Boyden AN, Colagiuri S. Maximising the effectiveness and cost-effectiveness of cardiovascular disease prevention in the general population. Med J Aust. 2009;191:300–302
  3. Seeman E, Kotowicz MA, Nash PT, Sambrook PN. Inappropriate prescribing for osteoporosis. Med J Aust. 2009;191:355–356
  4. Webster JR, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust. 2009;191:324–329
  5. Medi C, Hankey GJ, Freedman SB. Atrial fibrillation. Med J Aust. 2007;186:197–202
  6. Fitzgerald SP, Phillipov G. Patient attitudes to commonly promoted medical interventions. Med J Aust. 2000;172:9–12
  7. Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases. JAMA. 2005;294:716–724
  8. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51:S265–S280
  9. Durso SC. Using clinical guidelines designed for older adults with diabetes mellitus and complex health status. JAMA. 2006;295:1935–1940
  10. Jassal SV, Krahn MD, Naglie G, et al. Kidney transplantation in the elderly: a decision analysis. J Am Soc Nephrol. 2003;14:187–196
  11. Sommers BD, Beard CJ, D'Amico AV, et al. Decision analysis using individual patient preferences to determine optimal treatment for localized prostate cancer. Cancer. 2007;110:2210–2217
  12. Montgomery AA, Harding J, Fahey T. Shared decision making in hypertension: The impact of patient preferences on treatment choice. Family Practice. 2001;18:309–313
  13. Nagaki T, Sato K, Yoshida T, Yoshimoto Y. Benefit of carotid endarterectomy for symptomatic and asymptomatic severe carotid artery stenosis: A Markov model based on data from randomized controlled trials. J Neurosurg. 2009;111:970–977
  14. Elwyn G, Edwards A, Eccles M, Rovner D. Decision analysis in patient care. Lancet. 2001;358:571–574
  15. Nordin CBE, Horowitz M, Chatterton BE. Inappropriate prescribing for osteoporosis. Med J Aust. 2009;190:519–520
  16. Dimmitt SB, Stampfer HG. Low drug doses may improve outcomes in chronic Disease. Med J Aust. 2009;191:511–513
  17. Gialamas A, Yelland LN, Ryan P, et al. Does point-of-care testing lead to the same or better adherence to medication? A randomised controlled trial: the PoCT in General Practice Trial. Med J Aust. 2009;191:487–491
  18. Fitzgerald SP. The overall benefits risks and costs of multiple interventions may be less favourable than the sum of the benefits risks and costs of those individual interventions. Medical Hypotheses. 2007;69:970–973
  19. Crimmims EM, Hayward MD, Hagedorn A, et al. Change in disability-free life expectancy for Americans 70 years old and older. Demography. 2009;46:627–646
  20. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–1898
  21. Musini VM, Tejani AM, Bassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev. 2009;7:CD000028
  22. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial. Lancet. 2002;360:1623–1630
  23. Cutler DM, Rosen AB, Vigan S. The value of medical spending in the United States, 1960–2000. N Engl J Med. 2006;355:920–927
  24. Haughnessy AF, Slawson DC, Barnett BL. What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes. BMJ. 2003;327:266
  25. Deplanque D, Leys D, Parnetti L, et al. Stroke prevention and atrial fibrillation: Reasons leading to an inappropriate management. Main results of the SAFE II study. Br J Clin Pharmacol. 2004;57:798–806
  26. Shah AN, Vail TP, Taylor D, Pietrobon R. Comorbid illness affects hospital costs related to hip arthroplasty: Quantification of health status and implications for fair reimbursement and surgeon comparisons. J Arthroplasty. 2004;19:700–705
  27. Flaherty JH, Morley JE, Murphy DJ, Wasserman MR. The development of outpatient clinical glidepaths. J Am Geriatr Soc. 2002;50:1886–1901
  28. Winstein MC, Skinner JA. Comparative effectiveness and health care spending— Implications for reform. N Engl J Med. 2010;362:460–465
  29. Sanders GD, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med. 2005;353:1471–1480
  30. Hylek EM, Magnani JW. Methodological considerations for interpretation of rates of major haemorrhage in studies of anticoagulant therapy for atrial fibrillation. Europace. 2008;10:3–5
  31. Hylek EM, Evans-Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007;115:2689–2696
  32. Wyse DG. Bleeding while starting anticoagulation for thromboembolism prophylaxis in elderly patients with atrial fibrillation from bad to worse. Circulation. 2007;15:2684–2686
  33. Henriksson KM, Farahmand B, Johansson S, et al. Survival after stroke—The impact of CHADS2 score and atrial fibrillation. Int J Cardiol. 2010;141:18–23

 The authors have declared they have no conflicts of interest.

PII: S1525-8610(10)00184-2

doi: 10.1016/j.jamda.2010.05.008

JAMDA
Volume 11, Issue 7 , Pages 475-484 , September 2010