Prescriptions for Potentially Inappropriate Medications from the Beers Criteria Among Older Adults Hospitalized for Heart Failure

Jaber, Diana; León-Vargas, Fabián; Nguyen, Linh K.; Ringel, Joanna Bryan; Zarzuela, Kate; Musse, Mahad; Kwak, Min Ji; Levitan, Emily B; Maurer, Mathew S.; Lachs, Mark S.; Safford, Monika M.; Goyal, Parag

doi:10.1016/j.cardfail.2021.11.014

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…The REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study is a prospective cohort study that includes 30,239 White and Black community-dwelling men and women aged ≥ 45 years at enrollment recruited between 2003–2007 from all 48 contiguous states of the United States with ongoing follow-up [ 20 ]. The REGARDS study was originally designed to determine antecedents of racial and geographic differences in stroke mortality in the United States, and has since been used to study CV diseases including HF [ 12 , 15 , 21 , 22 ]. Participants were randomly sampled, with oversampling in the Southeastern US and of Black participants.…”

Section: Methodsmentioning

confidence: 99%

“…Finally, polypharmacy, which is nearly universal in older adults hospitalized for HF, is also a major risk factor for falls [ 12 – 14 ]. Despite these risk factors, older adults are often prescribed HF-specific medications in addition to medications for other conditions which increase the risk for hypotension, dizziness, and subsequent falls [ 12 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Liu¹,

Nahid²,

Musse³

et al. 2023

BMC Cardiovasc Disord

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Background Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden. Methods We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003–2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003–2017. We determined FRIDs –cardiovascular (CV) and non-cardiovascular (non-CV) medications – at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors. Results Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14). Conclusions FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Liu¹,

Nahid²,

Musse³

et al. 2023

BMC Cardiovasc Disord

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“…24 PIMs have also been reported to be more common in older adult patients hospitalized for HF. 27 In our registry, we assessed PIMs based on the Beers 2019 criteria, 28 and 5 medications (digitalis, amiodarone, proton pump inhibitors, nonsteroidal anti-inflammatory drugs [NSAIDs], and pioglitazone) were included as PIMs, although we were not able to determine whether digitalis and amiodarone were used as first-line agents for atrial fibrillation (Supplementary Table 7). After adjusting for demographics and comorbidities, we observed that each PIM and the total number of PIMs did not cause worse outcomes.…”

Section: Study Limitationsmentioning

confidence: 99%

Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure　― Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry ―

Kanai

Minamisawa

Motoki

et al. 2023

Circ J

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Background: Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure (ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF. Methods and Results:We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5-9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio [HR] per additional increase in the number of medications, 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02-1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92-1.10; P=0.95). Conclusions:Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.

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“… 87 , 88 Third, these risks are further exacerbated by medications commonly prescribed to treat CVD. 89 For example, antihypertensives, diuretics, nitrates, and beta-blockers can cause hypotension and syncope and thus predispose older adults to falls. 87 …”

Section: Essential Principles For Caring For Older Adults With Cvdmentioning

confidence: 99%

Geriatric Cardiology: Coming of Age

Goyal

Kwak²,

Malouf

et al. 2022

JACC: Advances

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Prescriptions for Potentially Inappropriate Medications from the Beers Criteria Among Older Adults Hospitalized for Heart Failure

Cited by 11 publications

References 33 publications

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure　― Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry ―

Geriatric Cardiology: Coming of Age

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Prescriptions for Potentially Inappropriate Medications from the Beers Criteria Among Older Adults Hospitalized for Heart Failure

Cited by 11 publications

References 33 publications

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure ― Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry ―

Geriatric Cardiology: Coming of Age

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Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure　― Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry ―