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El uso de metformina y tiazolidinediona en pacientes de Medicare con insuficiencia cardíaca
Frederick A Masoudi1, Yongfei Wang, Silvio E Inzucchi
1Division of Cardiology, Department of Medicine, Denver Health Medical Center, Colorado, USA.
JAMA
|July 3, 2003
Resumen
El uso de metformina y tiazolidinedionas en pacientes diabéticos con insuficiencia cardíaca ha aumentado significativamente, a pesar de las advertencias de la FDA. Se necesita más investigación para garantizar la seguridad del paciente y las estrategias de tratamiento óptimas.
Área de la Ciencia:
- Cardiología Cardiología.
- Endocrinología Endocrinología.
- Farmacología Farmacología.
Sus antecedentes:
- La metformina está contraindicada en pacientes con insuficiencia cardíaca, y las tiazolidinedionas no se recomiendan para la insuficiencia cardíaca avanzada.
- Existen datos limitados sobre los patrones de uso de estos fármacos antihiperglicémicos en pacientes diabéticos con insuficiencia cardíaca.
Objetivo del estudio:
- Determinar las tendencias de prescripción de metformina y tiazolidinedionas en pacientes hospitalizados con diabetes e insuficiencia cardíaca.
Principales métodos:
- Utilizó mediciones transversales en serie a partir de la abstracción retrospectiva de registros médicos.
- Se analizaron datos de dos muestras nacionales de beneficiarios de Medicare hospitalizados con insuficiencia cardíaca y diabetes entre 1998-1999 y 2000-2001.
Principales resultados:
- La prescripción de metformina o tiazolidinedionas en el momento de la descarga aumentó del 13,5% en 1998-1999 al 24,4% en 2000-2001.
- El uso de metformina aumentó del 7,1% al 11,2%, y el uso de tiazolidinediona aumentó del 7,2% al 16,1% durante el período de estudio.
- Esta tendencia fue consistente en todos los grupos demográficos.
Conclusiones:
- El uso de metformina y tiazolidinediona es frecuente y está aumentando rápidamente en pacientes diabéticos con insuficiencia cardíaca, en contra de las advertencias de la FDA.
- Se necesitan más estudios para evaluar la seguridad y eficacia de estos fármacos en esta población de pacientes.
- Asegurar una atención óptima para los pacientes con diabetes e insuficiencia cardíaca requiere una mayor investigación sobre estos patrones de prescripción.
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