J Clin Pharmacol
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DRUG SAFETY

National Veterans Health Administration Hospitalizations for Syncope Compared to Acute Myocardial Infarction, Fracture, or Pneumonia in Community-Dwelling Elders: Outpatient Medication and Comorbidity Profiles

Dustin D. French, MA, PhD, Robert Campbell, JD, MPH, PhD, Andrea Spehar, DVM, MPH, JD, Laurence Z. Rubenstein, MD, John Accomando, MD and Francesca Cunningham, PharmD

From the VISN-8 Patient Safety Center, James A. Haley Hospital, Tampa, Florida (Dr French, Dr Campbell, Dr Spehar); the University of South Florida College of Public Health, Tampa, Florida (Dr Spehar); Geriatric Research, Education and Clinical Center (GRECC), Sepulveda VA Medical Center and UCLA School of Medicine, North Hills, California (Dr Rubenstein); James A. Haley Hospital, Tampa, Florida (Dr Accomando); and the VHA Center for Medication Safety, Pharmacy Benefits Management, and the University of Illinois at Chicago, Chicago, Illinois (Dr Cunningham).

The authors used 2 national Veterans Health Administration databases to identify outpatient medications and all 30 Elixhauser comorbidities for 2579 unique patients, age 65+ years, hospitalized for syncope in fiscal year 2004. For comparison, we identified other elderly patients hospitalized with acute myocardial infarction (N = 4491), fracture (N = 2797), or pneumonia (N = 9473). The categories of medications included drugs that affect the cardiovascular, central nervous, or the muscular skeletal system. The most notable differences between syncope compared to acute myocardial infarction patients occurred in central nervous system drugs in anticonvulsants/barbiturates, antidepressants, antihistamine/antinauseants, antipsychotics, and cholinesterase inhibitors (P < .0018). Comparing syncope patients with fracture patients, the central nervous medication profile was similar, but the cardiovascular medication profile differed (P < .0018); their hypertension comorbidities also differed (60.45% vs 46.34%); (P < .0016). These findings indicate significant potential associations that warrant further study. Studies linking national outpatient medications to hospitalizations for specific conditions can foster the development of more proactive pharmacovigilance systems.

Key Words: Syncope • hospitalization • drugs • comorbidity • pharmacovigilance • veterans

Address for reprints: Dustin D. French, MA, PhD, VISN-8 Patient Safety Center, 13000 Bruce B. Downs Blvd. (118M), Tampa, FL 33612; e-mail: Dustin.French{at}med.va.gov; drddfrench{at}yahoo.com.


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