Management of Drug Therapy in the Elderly

Montamat, Stephen C.; Cusack, Barry J.; Vestal, Robert E.

doi:10.1056/nejm198908033210507

Cited by 332 publications

(19 citation statements)

References 68 publications

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“…Elderly patients are often underrepresented in RCTs [23], and diagnosis of coronary artery disease can be difficult as they can present with atypical symptoms [4]. Aged patients remain challenging to treat because of a higher prevalence of comorbidities and more frequent side effects or intolerance to drugs [24]. Reduction in angina attacks and consumption of short-acting nitrates has been previously shown in a subgroup of 91 elderly patients with stable angina in a pooled analysis of RCTs [16].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Werdan

Perings²,

Köster³

et al. 2016

Cardiology

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Objectives: The efficacy of ivabradine has been demonstrated in different subpopulations of stable angina patients in randomized clinical trials. This study explored its effectiveness in subpopulations seen in clinical practice as they often differ from those of randomized trials. Methods: Data were pooled from three German observational studies with similar inclusion criteria (stable angina and heart rate ≥60 bpm). All patients received 2.5, 5, or 7.5 mg b.i.d. of ivabradine for 4 months, with or without concomitant beta-blocker. Antianginal effectiveness was analyzed in subpopulations defined by gender, age, heart rate, angina severity, use of concomitant beta-blocker, previous percutaneous coronary intervention procedure, and comorbidities (including previous myocardial infarction and diabetes). Results: Treatment data were available on 8,555 patients, where therapy with ivabradine was associated with a significant reduction in the frequency of angina attacks and consumption of short-acting nitrates of 87%. Effectiveness was maintained in all investigated subpopulations, with a reduction in antianginal parameters of 82-90%. Clinical status (Canadian Cardiovascular Society class) and quality of life were also improved. Ivabradine was well tolerated in all subgroups. Conclusions: Ivabradine is effective and safe in all subpopulations of angina patients seen in clinical practice, independent of age, comorbidities, and use of beta-blocker.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Werdan

Perings²,

Köster³

et al. 2016

Cardiology

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“…First, angina is more likely to be severe [1] and more complex to treat in the elderly, in whom particular concerns relate to the use of polypharmacy with the potential for adverse drug interactions, relatively poor compliance, and variation in bioavailability [19]. Unfortunately, the elderly remain underrepresented in clinical trials [20, 21].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of <i>I</i><sub>f</sub> Inhibition with Ivabradine in Different Subpopulations with Stable Angina Pectoris

Tendera

Borer²,

Tardif³

2009

Cardiology

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Objectives: The antianginal and anti-ischemic efficacy of ivabradine has been demonstrated in large-scale trials. Pooling trial data allowed for subpopulation analyses of ivabradine’s antianginal efficacy. Methods: Data on the frequency of angina attacks, short-acting nitrate consumption, and heart rate were pooled from 5 randomized trials in patients with stable angina pectoris receiving 5, 7.5, or 10 mg of ivabradine b.i.d. for 3 or 4 months. The subpopulations were defined according to age, sex, disease characteristics, and comorbidities (severity of angina, history of myocardial infarction, cerebrovascular disease, revascularization status, diabetes, asthma/chronic obstructive pulmonary disease, or peripheral vascular disease). Results: Efficacy data were available for 2,425 patients (full analysis set), in whom ivabradine reduced the frequency of diary-based angina attacks by 59.4% and nitrate consumption by 53.7%. All subpopulations experienced 51–70% reductions in the frequency of angina attacks, with similar reductions for the other parameters studied. Ivabradine’s efficacy was maintained in the presence of different comorbidities. In the safety set, ivabradine reduced heart rate by 14.5%. Ivabradine had a good safety and tolerability profile in all the subpopulations assessed. Conclusions: The antianginal efficacy of ivabradine was consistent across all the subpopulations analyzed, independent of the severity of angina and the presence of a comorbidity.

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“…10,11,20 Therefore, there is a corresponding decrease in creatinine production which results in a stable serum creatinine with increasing age, despite a decline in renal function efficiency. Creatinine is a metabolic by-product of muscle metabolism and is mostly (97%) eliminated by glomerular filtration.…”

Section: Renal Systemmentioning

confidence: 99%

“…19,20 This measurement defines the volume (ml) of plasma from which creatinine is removed per unit time (min). Creatinine clearance is widely acknowledged as a good measure of renal function.…”

Section: Renal Systemmentioning

confidence: 99%

The Geriatric Patient: General Physiologic and Pharmacologic Considerations

Higbee

2000

Journal of Pharmacy Practice

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The elderly patient is not simply an older adult and needs to have drug therapy applied with caution with regard to the physiologic changes associated with aging that impact the pharmacology and pharmacokinetics of medicinals used in this population. The elderly patient has a number of physiologic changes with age that affect metabolism, distribution, and excretion. In addition, there exists information that demonstrates changes in the pharmacodynamics of drug therapy commonly used in the elderly. This article reviews these changes. SURVEYS HAVE DEMONSTRATED that most health care professionals are neither prepared to nor feel confident in delivering services to the geriatric population. This, coupled with negative stereotyping in the elderly by health care professionals, leads to inappropriate decisions for therapy and health care in general. In order to provide adequate pharmaceutical care to the elderly and avoid inappropriate use of medications, the practitioner needs to understand normal physiologic changes with age that impact the application of drug therapy in the older patient.2 2 THE ELDERLY POPULATION By definition, elderly are those 65 years of age or older. They comprise only 12.7% of the United States population, which translates into over 34.4 million people over age 65.2,3 This segment of the population continues to grow in numbers with estimations of over 70 million, or 20% of the population being elderly by the year Martin D Higbee, PharmD, CGP, The University of Arizona, College of Pharmacy, 1703 E Mabel, Tucson, AZ 85721.2030. Within this population, those over 75 years of age represent one of the fastest growing segments of our entire population. This is of concern to health care professionals since it is the 75-year-old and older persons who suffer the most consequences of disease and drug therapy due to a significantly diminished homeostatic reserve. That is, these elderly just don't &dquo;bounce&dquo; back as well as younger adults when stressed by disease or adverse drug effects. 2-5The elderly, despite their small percentage of the population, utilize a significant amount of health care resources.

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Management of Drug Therapy in the Elderly

Cited by 332 publications

References 68 publications

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Effectiveness of Ivabradine Treatment in Different Subpopulations with Stable Angina in Clinical Practice: A Pooled Analysis of Observational Studies

Efficacy of <i>I</i><sub>f</sub> Inhibition with Ivabradine in Different Subpopulations with Stable Angina Pectoris

The Geriatric Patient: General Physiologic and Pharmacologic Considerations

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