POLYPHARMACY IN ELDERLY STROKE PATIENTS: AN OBSERVATIONAL AND INTERVENTIONAL STUDY IN A PORTUGUESE STROKE UNIT

Background: Portugal’s population is ageing. High comorbidity and polypharmacy are associated to increased age. Although controversial, most authors define polypharmacy as 6 or more prescribed drugs. Polypharmacy represents increased risk of interaction and side-effects. Stroke is a critical event that demands review of long-term medication. To our knowledge, this is the first study to analyze the profile of highly medicated stroke patients. Methods: Observational study of routinely collected data over a 6-month period in a Stroke Unit of an Internal Medicine Department. Statistical analysis with T-test and chi-square test was performed. Results: 89 consecutive acute stroke patients reported during this period. Mean age 75.5±11.5 years, 59.6% women and 55.1% of patients had 6 or more drugs before admission. We found that polypharmacy patients were older (80.3±8.8 vs 69.7±11.9, p<0.001); had more established diagnosis (9.8 vs 7.7, p=0.01); higher Charlson Comorbidity Index (7.3 vs 4.0, p<0.001) and a higher prevalence of Dementia (34.7% vs 5.0%, p=0.001), Ischemic Heart Disease (86.7% vs 13.3%, p=0.007), Heart Failure (44.9 vs 10.0%, p<0.001) and Diabetes mellitus (46.9% vs 20.0%, p=0.008). At discharge, a reduction of 19.1% on the total amount of drugs was achieved. Conclusion: There is a high prevalence of polypharmacy in patients with acute stroke and an association to high comorbidity. Evidence-based guidelines may increase the total number of recommended drugs in stroke patients but, meanwhile, a reduction is observed. Criteria should be used to screen and stop potentially inappropriate medication (PIM). An interventional study on PIM is warranted in our unit.