Abstracts from the 33rd Annual Scientific Meeting of the Canadian Geriatrics Society Toronto, April 2013

Abstract

ed data, and appraised risk of bias using the Cochrane risk of bias tool. Random effects meta-analysis was conducted. Results: Nine randomized controlled trials were included after screening 15,676 titles and abstracts and 964 full-text articles. No significant findings were observed for impact on cognition (MMSE: 3 RCTs, mean difference [MD] 0.14, 95% confidence interval [CI] -0.22, 0.50, ADAS-cog 5 RCTs, MD -0.52, 95% CI -1.09, 0.06), although there was a trend towards favouring cognitive enhancers. Similarly, function was not significantly impacted (ADCS-ADL, 2 RCTs, MD 0.30, 95% CI -0.26, 0.86) and no trend was observed. Cognitive enhancers were associated with a higher risk of nausea (5 RCTs, relative risk [RR] 2.95, 95% CI 2.48, 3.52), diarrhea (5 RCTs, RR 2.71, 95% CI 1.90, 3.85), and vomiting (3 RCTs, RR 4.40, 95% CI 3.21, 6.03). Discussion & Conclusion: Cognitive enhancers did not improve cognition or function among patients with MCI and were associated with a greater risk of nausea, diarrhea, and vomiting. Adverse Cardiac Events in Older Patients receiving Venlafaxine: a Population-Based Study J. Ho3, T. Gomes1,2,3, S. Straus3,4,5, P. Austin6,7, M. Mamdani2,3,6,7, D. Juurlink6,7,8,9 1The Institute for Clinical Evaluative Sciences, Toronto, ON; 2The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON; 3Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON; 4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; 5Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON; 6The Institute for Clinical Evaluative Sciences, Toronto, ON; 7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; 8Department of Medicine, University of Toronto, Toronto, ON; 9The Sunnybrook Research Institute, Toronto, ON, Canada Background/Purpose: Venlafaxine is a commonly prescribed antidepressant, but it is unknown whether its noradrenergic effects impart an increased cardiovascular risk. Objective: To examine the cardiac safety of venlafaxine relative to sertraline in older patients. Methods: We conducted a retrospective cohort study using administrative health-care databases in Ontario, Canada. We included all patients aged 66 years or older who commenced treatment with either venlafaxine or sertraline between April 1, 2000 and March 31, 2009. We used inverse probability of treatment weighting (IPTW) with the propensity score to account for observed systematic differences between the two treatment groups. The primary outcome was a composite of death or hospitalization for acute myocardial infarction or congestive heart failure within the first year of therapy. In secondary analyses, each outcome was examined separately. Results: We studied 48,876 patients initiated on venlafaxine and 41,238 patients initiated on sertraline. Of these, 4259 (8.7%) and 3459 (8.4%) experienced the primary outcome, respectively. We found no significant difference in the risk of adverse cardiac events with venlafaxine relative to sertraline (hazard ratio 0.97; 95% confidence interval 0.94 to 1.02). Secondary analyses revealed no differences in the risk of death or acute myocardial infarction between the two drugs, but the risk of heart failure was unexpectedly lower among patients treated with venlafaxine (hazard ratio 0.87; 95% CI 0.80 to 0.95). We found consistent results after stratification according to pre-existing cardiovascular disease. Discussion & Conclusion: As compared with sertraline, venlafaxine is not associated with an increased risk of adverse cardiac events in older patients. What Is the Effectiveness of Quality Improvement Strategies on health-Care utilization Among frequent users? J. Antony1, P.A. Khan1, N. Ivers2, E. Blondal1, M. Ghassemi1, H. Ashoor1, H. MacDonald1, L. Kark Ezer1, S.E. Straus1, A.C. Tricco1 1Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toronto, ON, and 2Women’s College Hospital, University of Toronto, Toronto, ON, Canada Background/Purpose: Frequent users of emergency departments, clinics and hospitals utilize a disproportionately large amount of health-care resources, thereby reducing efficiency and decreasing overall quality of care. As such, efforts have been made to implement quality improvement (QI) strategies targeting this population. Our systematic review aims to identify effective care coordination QI strategies for frequent users. Methods: We searched multiple databases (e.g., Cochrane Library, EMBASE, MEDLINE) from earliest date to March 2012. Additional citations were identified by scanning the reference lists of included studies. Citations and full-text articles were screened by two independent reviewers and relevant studies were abstracted and appraised for quality in duplicate using the Cochrane Effective Practice and Organization of Care tool. Random effects meta-analyses were conducted using data from randomized clinical trials (RCTs).

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