The final, formatted version of the article will be published soon.
ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 15 - 2024 |
doi: 10.3389/fphar.2024.1476464
This article is part of the Research Topic Pharmacoepidemiology in Chronic Diseases View all articles
Potentially inappropriate prescribing in polymedicated older adults with atrial fibrillation and multimorbidity: A Swedish national register-based cohort study
Provisionally accepted- 1 Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- 2 Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
- 3 Karolinska institutet, Aging Research Center (ARC), Stockholm, Stockholm, Sweden
- 4 Stockholm Gerontology Research Center Foundation, Stockholm, Stockholm, Sweden
- 5 Department of Cardiovascular, Endocrine-Metabolic and Ageing-Associated Diseases, National Institute of Health (ISS), Rome, Lazio, Italy
- 6 Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
- 7 Ghent university, Department of Bioanalysis, Pharmaceutical Care Unit, Ghent, Belgium
- 8 Department of Clinical Sciences and Community Health, University of Milan, milan, Italy
- 9 Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- 10 Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- 11 Danish center for health services research, Department of clinical medicine, Aalborg University, Aalborg, Denmark
- 12 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
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 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 Swedish older adults nationwide. Swedish national registries were linked to establish a cohort with a two-year follow-up of older adults (≥ 65y) who, on 1 st 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. 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]). 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.
Keywords: Polypharmacy, Atrial Fibrillation, Inappropriate Prescribing, STOPP/START, adverse health outcomes Word count
Received: 05 Aug 2024; Accepted: 27 Aug 2024.
Copyright: © 2024 Amrouch, Vetrano, Damiano, Dai, Calderón-Larrañaga, Grymonprez, Proietti, Lip, Johnsen, Wastesson, Johnell, De Smedt and Petrovic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Cheima Amrouch, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.