Browsing by Author "Rajkumar, C"
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- Current Evidence on the Impact of Medication Optimization or Pharmacological Interventions on Frailty or Aspects of Frailty: a Systematic Review of Randomized Controlled TrialsPublication . Pazan, F; Petrovic, M; Cherubini, A; Onder, G; Cruz-Jentoft, A; Denkinger, M; van der Cammen, T; Stevenson, J; Ibrahim, K; Rajkumar, C; Bakken, M; Baeyens, JP; Crome, P; Frühwald, T; Gallaghar, P; Guðmundsson, A; Knol, W; O’Mahony, D; Pilotto, A; Rönnemaa, E; Serra-Rexach, JA; Soulis, G; van Marum, R; Ziere, G; Mair, A; Burkhardt, H; Neumann-Podczaska, A; Wieczorowska-Tobis, K; Fernandes, MA; Gruner, H; Dallmeier, D; Beuscart, J; van der Velde, N; Wehling, MBackground: Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. Methods: A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. Results: Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. Conclusion: So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.
- Protecting Older Patients with Cardiovascular Diseases from COVID-19 Complications Using Current MedicationsPublication . Alves, M; Fernandes, M; Bahat, G; Benetos, A; Clemente, H; Grodzicki, T; Martínez-Sellés, M; Mattace-Raso, F; Rajkumar, C; Ungar, A; Werner, N; Strandberg, T; EuGMS Special Interest Group in Cardiovascular MedicinePurpose: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.