347. Medication-related emergency department visits and hospitalizations among patients with systemic vasculitis
Creators: name: Arielle Mendel1, 2
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives</strong>: Patients with systemic vasculitis take a wide array of medications which place them at particular risk for adverse ug events (ADEs). A knowledge gap exists regarding the contribution of ADEs to emergency department (ED) visits or hospitalizations in vasculitis. Our objective was to determine the rate of ED visits within a cohort of systemic vasculitis patients, and to evaluate the proportion associated with potential ADEs. <strong>Methods:</strong> We studied patients enrolled in a longitudinal vasculitis registry between March 2017- February 2020. Data on demographics, disease characteristics, and medications were collected at baseline and annually. Within the cohort, all ED visits and hospitalizations to our centre (from enrolment until December 31, 2020) were identified from medical records. For each ED visit, we recorded reason for ED visit, current medications, and outcomes (diagnosis, disposition). Polypharmacy was defined as taking &gt;5 regular medications concurrently. The primary outcome was the occurrence of an ADE as a primary or secondary reason for the ED visit or hospitalization. Potential ADEs were adjudicated using the 6-point Leape-Bates scale (with scores of 4 representing a probable ADE). Crude event rates of ED visits, hospitalizations, and potential ADE-related ED visits were calculated with 95% confidence intervals, CI. <strong>Results:</strong> The cohort comprised 70 patients (24 granulomatosis with polyangiitis, 20 microscopic polyangiitis, 10 eosinophilic granulomatosis with polyangiitis, 4 giant cell arteritis, 5 Behcet’s synome, 2 primary angiitis of the CNS, 1 cryoglobulinaemic vasculitis, 4 polyarteritis nodosa). Within the entire cohort, mean disease duration was 7.2 (standard deviation, SD 6.6) years at enrolment. During cohort follow-up (mean of 2.8, SD 0.8, years), 15 ED visits occurred among 11 patients, for a rate of 7.7 visits (95% CI 4.7-12.5) per 100 patient-years. Characteristics of patients with at least 1 ED visit are described in Table 1. At the time of ED presentation, patients took a mean of 8.6 (SD 3.4) regular medications, and all patients took &gt; 5 medications at one or more ED visits. The majority of visits (11/15, 73%) occurred while patients were taking immunosuppressants. Nine of 15 (60%) ED visits required hospital admission (mean length of stay 9, SD 10 days) with the remainder being discharged from the ED. Following chart review, none of the visits were secondary to a vasculitis relapse, and 5 ED visits (33%, 95% CI, 15-58) were associated with potential ADEs (all related to immunosuppressants: 3 infections, 1 probable prion disease, 1 gastrointestinal upset), of which 3 required hospitalization. The rate of potential ADE-related ED visits was 2.6 (95% CI 1.1-6.1) per 100 patient-years. <strong>Conclusions:</strong> 1 in 6 patients with established vasculitis (mean disease duration &gt;7 years) visited the ED during cohort follow-up, and one third of these ED visits were potentially ADE-related. Polypharmacy, a known risk factor for ADEs, was extremely common. Further adjudication of medication-related ED visits will help to determine which may have been preventable. <strong>Disclosures:</strong> None.