Background Over the past decade, transcatheter aortic valve implantation (TAVI) has emerged as a novel and less invasive alternative to traditional surgical aortic valve replacement (SAVR) for the management of severe aortic stenosis (AS) in higher-risk elderly patients.
Purpose Our aim was to evaluate the frequency of polypharmacy (treatment with more than four medications per person) and to analyse the ATC class of medications prescribed in a fragile population.
Material and methods We analysed the data of patients whose medical procedures included TAVI or SAVR, between January 2016 and October 2017.
We identified a total of 903 patients who underwent TAVI (n=228) or SAVR (n=675), whose clinical characteristics were assessed by calculating the Charlson comorbidity index (CCI).
Results Patients in the TAVI group were more likely to be older (p<0.0001), female (p<0.01) and to have a higher CCI (p=0.05).
No significant difference in polypharmacy was observed between the two groups at discharge, after 6 and 9 months from the hospitalisation. In particular, the patients in polypharmacy, immediately after discharge, were 29% in the TAVI group and 35% in the SAVR group (p=0.07). After 6 months from discharge, the percentage of patients in polypharmacy had increased to over 80% in both groups and this data was confirmed after 9 months. In both groups, the most prescribed drugs at discharge were the antithrombotic agents (50.1% TAVI, 40.3% SAVR; p=0.005), followed by the drugs for peptic ulcer and gastroesophageal reflux disease (29.4% TAVI, 33.6% SAVR; p=0.24), high-ceiling diuretics (19.3% TAVI, 33.6% SAVR; p<0.0001) and beta-blocking agents (20.2% TAVI, 28.1% SAVR; p=0.018). The same evaluations on the prescribed medications were also made after 6 and 9 months.
Conclusion This first analysis found that polypharmacy was common in over one-third of our participants at discharge (both TAVI and SAVR group).
We found no association between polypharmacy and the type of AS treatment, but we observed some difference in the drug class between the two groups.
The next steps will be to investigate the presence of inappropriate drug combinations and to implement an inter-professional approach at discharge for improving polypharmacy issues.
References and/or acknowledgements All authors have declared that they have no support or funding to report.
No conflict of interest.