Potentially inappropriate prescribing in multimorbid and polymedicated older adults with AF: A Systematic Review and Meta-Analysis.

Autor: Amrouch C; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium. cheima.amrouch@ugent.be.; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. cheima.amrouch@ugent.be., Vauterin D; Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium., Amrouch S; Department of Medicine, Antwerp University, Antwerp, Belgium., Grymonprez M; Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium., Dai L; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden., Damiano C; Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy., Calderón-Larrañaga A; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; Stockholm Gerontology Research Center, Stockholm, Sweden., Lahousse L; Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium.; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands., De Bacquer D; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium., Lip GYH; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK., Vetrano DL; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; Stockholm Gerontology Research Center, Stockholm, Sweden., De Smedt D; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium., Petrovic M; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
Jazyk: angličtina
Zdroj: Drugs & aging [Drugs Aging] 2024 Jan; Vol. 41 (1), pp. 13-30. Date of Electronic Publication: 2023 Nov 17.
DOI: 10.1007/s40266-023-01078-6
Abstrakt: Aim: Polypharmacy in multimorbid older patients with atrial fibrillation (AF) is a risk factor for potentially inappropriate prescribing (PIP). We aimed to systematically assess the evidence on the prevalence of PIP and its impact on adverse health outcomes in this patient group.
Methods: A systematic search of the published peer-reviewed literature describing the prevalence of PIP and/or its association with adverse health outcomes in multimorbid (AF plus one comorbidity) and polymedicated (≥ 2 drugs) adults ≥ 65 years was done up to March 2023. A meta-analysis of the prevalence of PIP of (direct) oral anticoagulants ((D)OACs) was conducted using a random-effects model. Leave-one-out analysis was performed with R (version 4.2.2) and RStudio (version 2022.12.0+353).
Results: Of the 12 studies included, only one reported on the prevalence of overall PIP (65%). The meta-analysis of 10 studies assessing PIP of (D)OACs produced a pooled prevalence [95% confidence interval (CI)] of 35% [30-40%], with significant heterogeneity between the included studies (I 2 95%). No statistically significant association was reported in three studies between PIP of (D)OACs, cardiovascular (CV) and all-cause mortality, hospital readmission, CV hospitalisation and stroke. Reported associations between PIP and major bleeding differed, with one study demonstrating a significant association (odds ratio 2.17; 95% CI 1.14-4.12) and the other study not showing such association.
Conclusion: This systematic review highlights the scarce evidence regarding the prevalence of PIP and its association with adverse health outcomes in multimorbid older adults with AF. Large, prospective and better-designed studies are needed.
(© 2023. The Author(s).)
Databáze: MEDLINE
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