WEST HAVEN, CT — The good news, according to a recent study, is that medical intensive care unit (MICU) admissions have been declining in people with HIV infection (PWH). On the other hand, those patients now face greater frequency of outpatient polypharmacy, defined as the prescription of five or more chronic medications.
A study team led by the VA Connecticut Healthcare System examined whether outpatient polypharmacy increases the risk of subsequent one-year MICU admission or 10-year all-cause mortality, and if HIV status affects the association. Also participating in the study were VAMCs in Seattle; Pittsburgh; Washington, DC; and Houston.
For the retrospective cohort study appearing in PLOS One, the researchers used a national electronic health record cohort nearly 10,000 veterans in care. They quantified outpatient polypharmacy during fiscal year (FY) 2009 and followed patients for one-year MICU admission and 10-year mortality.1
The study assessed associations of any polypharmacy involving fewer than four, five-to-seven, eight-to-nine and 10 or more medications with those outcomes.
Results indicated that prior outpatient polypharmacy was common among 9,898 patients (1,811 PWH) hospitalized in FY2010, involving 51%. The researchers reported that, within a year, 15% had a MICU admission and, within 10 years, 46% died.
“Polypharmacy was associated with increased odds of 1-year MICU admission, in both unadjusted (odds ratio (OR) 1.36 95% CI: (1.22, 1.52)) and adjusted models, aOR (95% CI) = 1.28 (1.14, 1.43) and with 10-year mortality in unadjusted, hazard ratio (HR) (95% CI) = 1.40 (1.32, 1.48), and adjusted models, HR (95% CI) = 1.26 (1.19, 1.34),” the study determined. “Increasing levels of polypharmacy demonstrated a dose-response with both outcomes and by HIV status, with a stronger association among PWH.”
The authors concluded, that, among hospitalized patients, prior outpatient polypharmacy was associated with the defined outcomes after adjusting for severity of illness in PWH and those without HIV.
- Gordon KS, Crothers K, Butt AA, Edelman EJ, et. al. Polypharmacy and medical intensive care unit (MICU) admission and 10-year all-cause mortality risk among hospitalized patients with and without HIV. PLoS One. 2022 Oct 27;17(10):e0276769. doi: 10.1371/journal.pone.0276769. PMID: 36302039; PMCID: PMC9612570.
