Use of medications with pharmacogenomic guidelines and adverse outcomes in hospitalised older patients: a retrospective cross-sectional study

This study aimed to assess the prevalence of the use of medications with pharmacogenomic guidelines upon hospital admission in patients aged 65 and over and evaluate its association with adverse outcomes, including length of stay, unplanned admissions, and repeat hospital admissions. A retrospective cross-sectional study was conducted using hospital admissions data from 2018-2019 in one NHS hospital trust in England, focusing on patients aged 65 and over. The usage of medications with pharmacogenomic guidelines was examined, and comparisons were made between their prevalence in unplanned and planned admissions. Multivariable models assessed whether the use of medications with pharmacogenomic guidelines were associated with adverse outcomes, considering frailty status. Analysis of 59,973 admissions revealed 67 pharmacogenomics medicines as per the Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines, with 11 classified as high-risk among 1438 unique medicines identified from 560,179 recorded medications. Notably, unplanned admissions exhibited a higher prevalence of medications with pharmacogenomic guidelines (84% versus 64%, p < 0.001) compared to planned admissions. The models demonstrated the usage of these medications was associated with adverse outcomes (length of stay in hospital, unplanned admission and repeat hospital admission) with substantial evidence (Delta_AICc < 2) particularly in patients with high frailty status. This study highlights the association between medications with pharmacogenomic guidelines and adverse outcomes, particularly among patients with high frailty. The findings emphasise the importance of integrating pharmacogenomic-guided care into the management of older individuals with frailty to mitigate adverse outcomes and enhance medication safety.