1. IS AGE AN INDEPENDENT PREDICTOR OF ADVERSE DRUG EVENTS TO LOOP DIURETICS? UMDNJ - SOM Wunhuey Cheng D.O. Mentored by Anita Chopra M.D. Sherry Pomerantz Ph.D.

2. INTRODUCTION  Patients > 65 years are more likely to experience ADEs. 1  33% of frail elderly discharged from hospitals had ADRs. 2  Diuretics cause 22% of preventable ADEs in adults > 65 years. 3  Loop diuretics are needed to treat CHF, hypertension, and edema SPECIFIC AIM  Determine if age is an independent predictor of ADEs related to loop diuretics in the general population admitted to the hospital. 1. Budnitz et al. National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events. JAMA. 2006; 296: 1858 – 1866. 2. Hanlon et al. Incidence &Predictors of All & Preventable ADR in Frail Elderly Persons After Hospital Stay. J of Gerontology. 2006. 61A: 511-515. 3. Gurwitz et al. Incidence and Preventability of Adverse Drug Events Among Older Persons in Ambulatory Setting. JAMA. 2003; 289:1107-1116.

3. METHODS  Hospital pharmacy database identified patients  Admitted to South Jersey hospital system between 2009 to 2011  Treated with loop diuretics (furosemide, torsemide, bumetanide)  Retrospective chart review of 321 patients  Group A: + ADE related to loop diuretic  Group B: - ADE related to loop diuretic  ADEs related to loop diuretics were defined as:  Acute kidney injury with volume depletion, Dehydration  Hypotension, Syncope, Falls, Dizziness, Arrhythmias  ADE occurred within 48 hr of loop diuretic & required D/C of med  Analysis: T-Test, Chi square, Logistic regression

4. RESULTS Table 1: Comparison of Patients With and Without Adverse Drug Events ADE (Group A)No ADE (Group B) 121 patients200 patients Baseline VariablesMean (SD) Mean (SD)P value Age73.9 + 11.670.9 + 15.00.045 Cr Clearance (mL/min)75.2 + 49.487.2 + 53.50.046 MAP (mm Hg)90.3 + 17.797.0 + 17.20.001 Number of meds12 + 411 + 40.016 Number of comorbidities10.1 + 3.08.5 + 2.90.000 Charlson Comorbidity Index 5.4 + 2.34.1 + 2.40.000 N (% Group A)N (% Group B)P value Prior History of Bleed25 (21%)17 (9%)0.002 Prior History of Hypotension24 (20%)15 (8%)0.001 Beta blockers90 (75%)119 (60%)0.007

5. RESULTS Table 2: Logistic Regression of Significant Variables Related to ADE P-value Odds Ratio 95% CI Baseline Creatinine Clearance > 72 0.798 0.9220.495 to 1.718 Total # of medications > 11 0.875 1.0430.620 to 1.754 MAP > 94 before loop diuretic 0.023 0.5560.336 to 0.921 Charlson Comorbidity Index > 5 0.013 1.9361.149 to 3.262 Beta-Blocker 0.025 1.8681.083 to 3.223 Prior History of Hypotension 0.013 2.6011.222 to5.537 Prior History of Bleeds 0.003 3.0231.464 to 6.244 Age 0.356 1.0110.988 to1.035 CONCLUSIONS  Age was not an independent predictor of ADEs to loop diuretics.  The decision to administer loop diuretics should be based on patient’s blood pressure and comorbidities, but not age.

6. Thank You. QUESTIONS?