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Archived Comments for: Cardiovascular polypharmacy is not associated with unplanned hospitalisation: evidence from a retrospective cohort study

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  1. Is adequate polypharmacy existing?

    Stefan Neuner-jehle, Institute of general practice and health services research Z├╝rich

    25 April 2014

    As Sarah Appleton and colleagues are pointing out, polypharmacy is not necessarily negative or the result of an unsufficient "good clinical practice", in spite of its potential to harm. Their finding that a higher number of cardiovascular medicaments per patient do not lead to an increased general hospitalization rate suggests that mostly the indications to prescribe these medicaments are correct and their use beneficial to the patient.

    Thus, sometimes polypharmacy is not necessarily negative, given that the patient is suffering from multiple diseases or conditions making him or her sick. As a consequence, mathematically driven tools to reduce polypharmacy might not successfully improve the patient's condition but sometimes drive them into undertreatment.

    It would be interesting if the study authors did run a subgroup analysis concerning anticoagulants and platelet inhibitors, as these are known to cause a majority of adverse side effects leading to hospitalizations in patients with polypharmacy (1). The relevant question is: Are the benefits of anticoagulants and platelet inhibitors outweighting their risks in patients with polypharmacy? If the indication for these group of medicaments is correct in most patients of the study population, the answer should be yes, and the main finding (hospitalization rate not increased)should therefore be robust also in this subgroup. 

    Many thanks to the authors in advance for a reply, if they did an subgroup analysis on this question (the high number of participants probably will make this statistically feasible), and for their interesting and important work.                       


    Stefan M. Neuner-Jehle

    Institut of General Medicine and Health Services Research, University of Zurich, 8091 Zurich, Switzerland  



    1    Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for  adverse drug events in older americans. N Engl J Med 2011; 365(21): 2002-2012

    Competing interests

    No competing interests declared.
  2. Reply to comment regarding antiplatelets and anticoagulants.

    Sarah Appleton, NHS

    29 April 2014

    Although our cardiovascular medicine count included antiplatelets and anticoagulants, we did not conduct any additional analysis on this particular sub-group. An important issue is knowing the clinical indication for the drug, which is not always easy to determine from routine data such as those employed by our study, and specific outcomes related to use of these particular drugs (e.g. bleeding) are not available from our data. We will, however, consider the suggestion made.

    Competing interests

    None declared