老年人心血管疾病合并神经精神疾病多重用药风险防控专家共识

标题: 老年人心血管疾病合并神经精神疾病多重用药风险防控专家共识
title: Expert consensus on risk prevention and control of polypharmacy for cardiovascular disease combined with neuropsychiatric disease in the elderly
版本: 原创版
version: Original
分类: 专家共识
classification: Experts consensus
领域: 综合
field: Comprehensive guideline
国家和地区: 中国
Country and region: China
指南使用者: 医生、药师、患者
Guide users: Doctors, Pharmacists, Patients
证据分级方法: 牛津大学循证医学中心证据分级与推荐意见
Evidence grading method: Oxford University Centre for Evidence-Based Medicine Evidence Grading and Recommendations
制定单位: 中华医学会临床药学分会;上海交通大学医学院附属新华医院
Formulating unit: Clinical Pharmacy Branch of Chinese Medical Association;Department of Clinical Pharmacy, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine
注册时间: 2022-06-28
Registration time:
注册编号: IPGRP-2022CN367
Registration number:
指南制订的目的: 我国是世界上老龄人口最多的国家,预计在未来二十年仍将继续快速增长,2026年60岁以上老年人口将达3.04亿,2039年将达4亿,老龄化已经成为重大的社会问题。老年人常同时患有多种慢性疾病。在我国,42%的老年人同时患有两种及以上疾病,其中心血管系统疾病和神经精神疾病组合是最为常见的多病共患之一。有研究显示心血管疾病患者伴发抑郁、焦虑的比例比较高,分别是22.8%、70.9%。多病共患的老年人,由于本身病理生理学的改变,更易于发生药物不良反应。同时,该类病人多重用药非常普遍,也增加药物不良反应、不良药物相互作用的发生率,部分可能会导致严重的后果。 采用科学的标准对老年患者的潜在不适当用药加以评估,可以早期发现潜在不适当用药,防范不良事件的发生,并指导临床更合理地用药。目前许多国家和地区已经制定了相应的老年人潜在不适当用药评估标准或指南,但每个标准各有侧重,其地域局限性、标准差异性、覆盖面差异以及循证证据的缺乏非常明显(Beers标准除外),并且均未涉及老年人多病共患情形下,潜在不适当用药的情况。本专家共识将主要关注心血管疾病合并神经精神疾病状态下,老年人潜在不适当用药,在借鉴国外评估工具的基础上,尽可能利用循证的方法,完善我国老年人心血管疾病合并神经精神疾病状态下,潜在不适当用药评估标准,并积极推广于临床实践,以降低我国老年人的不良临床结局。
Purpose of the guideline: China is the country with the largest aging population in the world, and it is expected to continue to grow rapidly in the next two decades. In 2026, the population of the elderly over the age of 60 will reach 304 million, and in 2039, it will reach 400 million. Aging has become a major social problem. Elderly people often suffer from multiple chronic diseases at the same time. In China, 42% of the elderly suffer from two or more diseases at the same time, of which the combination of cardiovascular system diseases and neuropsychiatric diseases is one of the most common multi-disease comorbidities. Studies have shown that the proportion of patients with cardiovascular disease associated with depression and anxiety is relatively high, 22.8% and 70.9%, respectively. Elderly people with multiple diseases are more prone to adverse drug reactions due to their own pathophysiological change. Meanwhile, multiple medication is very common in these patients, which also increases the incidence of adverse drug reactions and adverse drug interactions, some of which may lead to serious consequences. Using scientific standards to evaluate potential inappropriate drug use in elderly patients can detect potential inappropriate drug use early, prevent the occurrence of adverse events, and guide clinical use of drugs more rationally. At present, many countries and regions have formulated corresponding standards or guidelines for the assessment of potentially inappropriate drug use in the elderly, but each standard has its own emphasis, its geographical limitations, standard differences, differences in coverage and lack of evidence-based evidence are very obvious (Beers standard), and none of them involve potentially inappropriate drug use in the context of multiple comorbidities in the elderly. This expert consensus will mainly focus on the potential inappropriate medication of the elderly in the state of cardiovascular disease combined with neuropsychiatric disease. On the basis of drawing on foreign assessment tools, use evidence-based methods as much as possible to improve the elderly with cardiovascular disease combined with neuropsychiatric disease in China. In order to reduce the adverse clinical outcomes of the elderly in my country, the evaluation criteria for potentially inappropriate drug use should be actively promoted in clinical practice.