Potentially inappropriate prescribing in polymedicated older adults with atrial fibrillation and multimorbidity: a Swedish national register-based cohort study.

Autor:	Amrouch C; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium., Vetrano DL; Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; Stockholm Gerontology Research Center, Stockholm, Sweden., Damiano C; Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy., Dai L; Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden., Calderón-Larrañaga A; Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; Stockholm Gerontology Research Center, Stockholm, Sweden., Grymonprez M; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.; Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium., Proietti M; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.; Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy., Lip GYH; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Johnsen SP; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Wastesson JW; Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Johnell K; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 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:	Frontiers in pharmacology [Front Pharmacol] 2024 Sep 10; Vol. 15, pp. 1476464. Date of Electronic Publication: 2024 Sep 10 (Print Publication: 2024).
DOI:	10.3389/fphar.2024.1476464
Abstrakt:	Introduction: Current research on potentially inappropriate prescribing (PIP) in polymedicated older adults with atrial fibrillation (AF) and multimorbidity is predominantly focused on PIP of oral anticoagulants (OAC). Our study aimed to assess (i) the overall prevalence of PIP in older multimorbid adults with AF, (ii) potential associated factors of PIP, and (iii) the association of PIP with adverse health outcomes in a nationwide sample of Swedish older adults. Methods: Swedish national registries were linked to establish a cohort with a 2-year follow-up of older adults (≥65y) who, on 1 January 2017, had a diagnosis of AF and had at least one comorbidity (n = 203,042). PIP was assessed using the reduced STOPP/START version 2 screening tool. The STOPP criteria identify potentially inappropriate prescribed medications (PIM), while the START criteria identify potential prescribing omissions (PPO). PIP is identified as having at least one PIM and/or PPO. Cox regression analyses were conducted to examine the association between PIP and adverse health outcomes: mortality, hospitalisation, stroke, bleeding, and falls. Results: PIP was highly prevalent in older adults with AF, with both polypharmacy (69.6%) and excessive polypharmacy (85.9%). In the study population, benzodiazepines (22.9%), hypnotic Z-medications (17.8%) and analgesics (8.7%) were the most frequent PIM. Anticoagulants (34.3%), statins (11.1%), vitamin D and calcium (13.4%) were the most frequent PPO. Demographic factors and polypharmacy were associated with different PIM and PPO categories, with the nature of these associations differing based on the specific type of PIM and PPO. The co-occurrence of PIM and PPO, compared to appropriate prescribing, was associated with an increased risk of adverse health outcomes compared to all appropriately prescribed medications: cardiovascular (CV) (Hazard ratio (HR) [95% confidence interval] = 1.97 [1.88-2.07]) and overall mortality (HR = 2.09 [2.03-2.16]), CV (HR = 1.34 [1.30-1.37]) and overall hospitalisation (HR = 1.48 [1.46-1.51]), stroke (HR = 1.93 [1.78-2.10]), bleeding (HR = 1.10 [1.01-1.21]), and falls (HR = 1.63 [1.56-1.71]). Conclusion: The present study reports a high prevalence of PIP in multimorbid polymedicated older adults with AF. Additionally, a nuanced relationship between prescribing patterns, patient characteristics, and adverse health outcomes was observed. These findings emphasise the importance of implementing tailored interventions to optimise medication management in this patient population. Competing Interests: MG declares that he received a research grant from the Research Foundation Flanders (project number 11C0820N). Additionally, he declares payment to his institution for giving lectures to IPSA, a non-profit organisation. GL declares consultancy and speaker fees from BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. MP declares that he is the President of the European Geriatric Medicine Society. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Amrouch, Vetrano, Damiano, Dai, Calderón-Larrañaga, Grymonprez, Proietti, Lip, Johnsen, Wastesson, Johnell, De Smedt and Petrovic.)
Databáze:	MEDLINE
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