Renate Quinzler1, Michael H Freitag2, Birgitt Wiese3, Martin Beyer4, Hermann Brenner5, Anne Dahlhaus4, Angela Döring6, Tobias Freund7, Margit Heier6, Hildtraud Knopf8, Melanie Luppa9, Jana Prokein3, Steffi G Riedel-Heller9, Ingmar Schäfer10, Christa Scheidt-Nave8, Martin Scherer10, Ben Schöttker5, Joachim Szecsenyi7, Petra Thürmann11, Hendrik van den Bussche10, Jochen Gensichen12, Walter E Haefeli13. 1. Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. 2. Division of General Practice, Department of Health Services Research, University of Oldenburg, 26111 Oldenburg, Germany; Institute of General Practice and Family Medicine, Universitätsklinikum Jena, Bachstr. 18, 07743 Jena, Germany. 3. Institute of General Practice, WG Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany. 4. Institute of General Practice, Goethe-University Frankfurt am Main, 60590 Frankfurt am Main, Germany. 5. Division of Clinical Epidemiology and Aging Research, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69120 Heidelberg, Germany. 6. Institut für Epidemiologie, Helmholtz Zentrum München, 85764 Neuherberg, Germany. 7. Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany. 8. Robert Koch-Institut, Abteilung Epidemiologie und Gesundheitsmonitoring, 12101 Berlin, Germany. 9. Institute of Social Medicine, Occupational Health and Public Health (ISAP) University of Leipzig, Faculty of Medicine, Philipp-Rosenthal-Straße 55, 04103 Leipzig. 10. Universitätsklinikum Hamburg-Eppendorf, Institut für Allgemeinmedizin, 20246 Hamburg, Germany. 11. Lehrstuhl für Klinische Pharmakologie, Department für Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Germany; Philipp Klee-Institut für Klinische Pharmakologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany. 12. Institute of General Practice and Family Medicine, Universitätsklinikum Jena, Bachstr. 18, 07743 Jena, Germany; Institute of General Practice and Family Medicine, University Hospital of LMU Munich, Pettenkoferstr. 8a/10, 80336 München, Germany. 13. Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: walter.emil.haefeli@med.uni-heidelberg.de.
Abstract
OBJECTIVES: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. STUDY DESIGN AND SETTING: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample; MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes. RESULTS: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex). CONCLUSIONS: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores.
OBJECTIVES: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. STUDY DESIGN AND SETTING: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample; MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes. RESULTS: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex). CONCLUSIONS: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores.
Authors: Robin Brünn; Dorothea Lemke; Jale Basten; Petra Kellermann-Mühlhoff; Juliane Köberlein-Neu; Christiane Muth; Marjan van den Akker Journal: Pharmaceuticals (Basel) Date: 2022-06-17
Authors: Robin Brünn; Dorothea Lemke; Kiran Chapidi; Juliane Köberlein-Neu; Alexandra Piotrowski; Sara Söling; Wolfgang Greiner; Petra Kellermann-Mühlhoff; Nina Timmesfeld; Marjan van den Akker; Christiane Muth Journal: Ther Adv Drug Saf Date: 2022-01-22