Guideline concordant prescribing following myocardial infarction in people who are frail: A systematic review.

Autor: Doody H; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Pharmacy Department, Launceston General Hospital, Tasmania, Australia., Livori A; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Grampians Health, Ballarat, Victoria, Australia., Ayre J; Pharmacy Department, Launceston General Hospital, Tasmania, Australia., Ademi Z; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; School of Public Health and Preventive Medicine, Monash University, Australia., Bell JS; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia., Morton JI; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia. Electronic address: jedidiah.morton@monash.edu.
Jazyk: angličtina
Zdroj: Archives of gerontology and geriatrics [Arch Gerontol Geriatr] 2023 Nov; Vol. 114, pp. 105106. Date of Electronic Publication: 2023 Jun 18.
DOI: 10.1016/j.archger.2023.105106
Abstrakt: Aims: The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of guideline-recommended cardioprotective medications following myocardial infarction (MI) in people who are frail.
Data Sources: Ovid Medline, PubMed and Cochrane were searched from inception to October 2022 for studies that reported prescribing of one or more cardioprotective medication classes post-MI or acute coronary syndromes in people with frailty.
Study Selection: We included observational studies that reported prescribing of cardioprotective medications post-MI stratified by frailty status.
Results: Overall, 16 cohort studies published from 2013 to 2022 that used seven different frailty scales were included. Prescribing of all cardioprotective medication classes following MI was lower in frail compared to non-frail people, with absolute rates of prescribing varying substantially across studies. Median prescribing in frail and non-frail people, respectively, was 88.9% (IQR 81.5-96.2) and 93.1% (IQR 92.0-98.9) for aspirin; 68.1% (IQR 61.9-91.2) and 86.7% (IQR 79.5-92.8) for P2Y12-inhibitors; 83.1% (IQR 76.9-91.3) and 94.0% (IQR 87.1-95.9) for lipid-lowering therapy; 67.9% (IQR 60.6-74.0) and 74.7% (IQR 71.3-84.5) for angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; and 74.1% (IQR 69.2-79) and 77.6% (IQR 71.8-85.9) for beta-blockers.
Conclusion: People who were frail were less likely to be prescribed guideline recommended medication classes post-MI than those who were non-frail. Further research is needed into treatment benefits and risks in frail people to avoid unnecessarily withholding treatment in this high-risk population, while also minimising potential for medication related harm.
Competing Interests: Declaration of Competing Interest The following potential conflicts are declared: ZA declares research funding from Amgen Australia received through their institution outside of the submitted work. JSB has received grant funding or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Victorian Government Department of Health, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations unrelated to this work; all grants and consulting funds were paid to the employing institution. No direct research funding has been received for this study. No other potential conflicts of interest are declared.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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