Association of a calcium channel blocker and diuretic prescribing cascade with adverse events: A population-based cohort study.

Autor: Rochon PA; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Austin PC; ICES, Toronto, Ontario, Canada.; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Normand SL; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA., Savage RD; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada., Read SH; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada., McCarthy LM; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada., Giannakeas V; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada., Wu W; Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada., Strauss R; ICES, Toronto, Ontario, Canada., Wang X; ICES, Toronto, Ontario, Canada., Chen S; ICES, Toronto, Ontario, Canada., Gurwitz JH; Division of Geriatric Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Feb; Vol. 72 (2), pp. 467-478. Date of Electronic Publication: 2023 Nov 27.
DOI: 10.1111/jgs.18683
Abstrakt: Background: Prescribing cascades occur when a drug adverse event is misinterpreted as a new medical condition and a second, potentially unnecessary drug, is prescribed to treat the adverse event. The population-level consequences of prescribing cascades remain unknown.
Methods: This population-based cohort study used linked health administrative databases in Ontario, Canada. The study included community-dwelling adults, 66 years of age or older with hypertension and no history of heart failure (HF) or diuretic use in the prior year, newly dispensed a calcium channel blocker (CCB). Individuals subsequently dispensed a diuretic within 90 days of incident CCB dispensing were classified as the prescribing cascade group, and compared to those not dispensed a diuretic, classified as the non-prescribing cascade group. Those with and without a prescribing cascade were matched one-to-one on the propensity score and sex. The primary outcome was a serious adverse event (SAE), which was the composite of emergency room visits and hospitalizations in the 90-day follow-up period. We estimated hazard ratios (HRs) with 95% confidence intervals (CI) for SAE using an Andersen-Gill recurrent events regression model.
Results: Among 39,347 older adults with hypertension and no history of HF who were newly dispensed a CCB, 1881 (4.8%) had a new diuretic dispensed within 90 days after CCB initiation. Compared to the non-prescribing cascade group, those in the prescribing cascade group had higher rates of SAEs (HR: 1.21, 95% CI: 1.02-1.43).
Conclusions: The CCB-diuretic prescribing cascade was associated with an increased rate of SAEs, suggesting harm beyond prescribing a second drug therapy. Our study raises awareness of the downstream impact of the CCB-diuretic prescribing cascade at a population level and provides an opportunity for clinicians who identify this prescribing cascade to review their patients' medications to determine if they can be optimized.
(© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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