5e7b356370974646a69303ca43a6a04b pmc_9777651.pdf 489055a26e16bf82e5bfb06434c5be5bfa4ae531 pmc_9777651.pdf bef00ec62ba494d55b338ecf864ed5ab42058f48ad3cf6acd48421517c2c90f6 pmc_9777651.pdf Title: Polypharmacy Patterns in Multimorbid Older People with Cardiovascular Disease: Longitudinal Study Subject: (1) Introduction: Cardiovascular disease is associated with high mortality, especially in older people. This study aimed to characterize the evolution of combined multimorbidity and polypharmacy patterns in older people with different cardiovascular disease profiles. (2) Material and methods: This longitudinal study drew data from the Information System for Research in Primary Care in people aged 65 to 99 years with profiles of cardiovascular multimorbidity. Combined patterns of multimorbidity and polypharmacy were analysed using fuzzy c-means clustering techniques and hidden Markov models. The prevalence, observed/expected ratio, and exclusivity of chronic diseases and/or groups of these with the corresponding medication were described. (3) Results: The study included 114,516 people, mostly men (59.6%) with a mean age of 78.8 years and a high prevalence of polypharmacy (83.5%). The following patterns were identified: Mental, behavioural, digestive and cerebrovascular; Neuropathy, autoimmune and musculoskeletal; Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological; Non-specific; Multisystemic; Respiratory, cardiovascular, behavioural and genitourinary; Diabetes and ischemic cardiopathy; and Cardiac. The prevalence of overrepresented health problems and drugs remained stable over the years, although by study end, cohort survivors had more polypharmacy and multimorbidity. Most people followed the same pattern over time; the most frequent transitions were from Non-specific to Mental, behavioural, digestive and cerebrovascular and from Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological to Non-specific. (4) Conclusions: Eight combined multimorbidity and polypharmacy patterns, differentiated by sex, remained stable over follow-up. Understanding the behaviour of different diseases and drugs can help design individualised interventions in populations with clinical complexity. Keywords: polypharmacy; multimorbidity; elderly; cardiovascular disease; chronic disease; combined patterns; clustering; primary healthcare Author: Noemí Villén, Albert Roso-Llorach, Carlos Gallego-Moll, Marc Danes-Castells, Sergio Fernández-Bertolin, Amelia Troncoso-Mariño, Monica Monteagudo, Ester Amado and Concepción Violán Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Dec 13 05:40:05 2022 CET ModDate: Tue Dec 13 06:55:30 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 19 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 862329 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 JECVIE+VnURWPalladioL Type 1 Custom yes yes no 15 0 TQCUVT+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 YDTJGZ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 SLZZUY+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 AEIEME+CMSY10 Type 1 Builtin yes yes no 32 0 UXFKPM+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 PHAEFH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 82 0 PHAEGJ+PalatinoLinotype TrueType WinAnsi yes yes no 85 0 PHAEGL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 88 0 CKBPVA+EURM10 Type 1 Builtin yes yes no 98 0 PHAEFH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 111 0 PHAEGI+PalatinoLinotype CID TrueType Identity-H yes yes yes 114 0 PHAEGJ+PalatinoLinotype TrueType WinAnsi yes yes no 120 0 PHAEGL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 123 0 PHAEFH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 163 0 PHAEGI+PalatinoLinotype CID TrueType Identity-H yes yes yes 166 0 PHAEGJ+PalatinoLinotype TrueType WinAnsi yes yes no 172 0 PHAEGL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 175 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-08-10 02:26:18 CEST RepresentationInformation: pmc_9777651.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-08-03 02:20:55 CEST Size: 862329 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 388 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Design, Setting, and Population Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Data Source Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Children: Item: Title: Chronic Diseases and Multimorbidity Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Drugs and Classification Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Drug Groups and Chronic Disease Mapping Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Analytical Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Demographic and Socioeconomic Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Info: Title: Polypharmacy Patterns in Multimorbid Older People with Cardiovascular Disease: Longitudinal Study Author: Noemí Villén, Albert Roso-Llorach, Carlos Gallego-Moll, Marc Danes-Castells, Sergio Fernández-Bertolin, Amelia Troncoso-Mariño, Monica Monteagudo, Ester Amado and Concepción Violán Subject: (1) Introduction: Cardiovascular disease is associated with high mortality, especially in older people. This study aimed to characterize the evolution of combined multimorbidity and polypharmacy patterns in older people with different cardiovascular disease profiles. (2) Material and methods: This longitudinal study drew data from the Information System for Research in Primary Care in people aged 65 to 99 years with profiles of cardiovascular multimorbidity. Combined patterns of multimorbidity and polypharmacy were analysed using fuzzy c-means clustering techniques and hidden Markov models. The prevalence, observed/expected ratio, and exclusivity of chronic diseases and/or groups of these with the corresponding medication were described. (3) Results: The study included 114,516 people, mostly men (59.6%) with a mean age of 78.8 years and a high prevalence of polypharmacy (83.5%). The following patterns were identified: Mental, behavioural, digestive and cerebrovascular; Neuropathy, autoimmune and musculoskeletal; Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological; Non-specific; Multisystemic; Respiratory, cardiovascular, behavioural and genitourinary; Diabetes and ischemic cardiopathy; and Cardiac. The prevalence of overrepresented health problems and drugs remained stable over the years, although by study end, cohort survivors had more polypharmacy and multimorbidity. Most people followed the same pattern over time; the most frequent transitions were from Non-specific to Mental, behavioural, digestive and cerebrovascular and from Musculoskeletal, mental, behavioural, genitourinary, digestive and dermatological to Non-specific. (4) Conclusions: Eight combined multimorbidity and polypharmacy patterns, differentiated by sex, remained stable over follow-up. Understanding the behaviour of different diseases and drugs can help design individualised interventions in populations with clinical complexity. 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