What question did this study set out to answer?

To estimate how guideline recommended drugs affect survival in older adults with multiple chronic conditions.

October 2, 2015BMJOpen Access

Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study

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Why the study?

Do guideline recommended drugs reduce death in older adults with multiple chronic conditions?

Population

8,578 older adults with two or more chronic conditions, from a nationally representative US sample.

Comparison

Guideline recommended drugs including beta… vs Participants with the same condition not taking…

Design

Cohort

Follow-up

3 years

Authors

MTMary E. TinettiUniversity of North Carolina at Chapel Hill GMGail McAvayYale University MTMark TrentalangeHospital for Special Surgery

Discussion

Member takes

Implication

May inform deprescribing decisions in multimorbid older adults; leaves open causal confirmation in randomized trials.

Key Points

To estimate how guideline recommended drugs affect survival in older adults with multiple chronic conditions.
Population based cohort study using Medicare Current Beneficiary Survey data.
Followed 8578 adults aged 65 and older with at least two chronic conditions through 2011.
Analyzed the association between specific drugs and death rates using adjusted hazard ratios.
15% of participants died during the three-year follow-up.
β blockers and RAS blockers associated with reduced mortality in relevant conditions (e.g., β blockers HR 0.59 for atrial fibrillation).
Warfarin reduced death risk for patients with atrial fibrillation (HR 0.69) and thromboembolic disease (HR 0.44).

Structured PICO

Do guideline recommended drugs reduce death in older adults with multiple chronic conditions?

Population

8,578 older adults (aged ≥65 years) with two or more chronic conditions (atrial fibrillation, coronary artery disease, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, and thromboembolic disease), from a nationally representative US sample (Medicare Current Beneficiary Survey cohort).

Intervention

Guideline recommended drugs including beta blockers, calcium channel blockers, clopidogrel, metformin, renin-angiotensin system (RAS) blockers, SSRIs/SNRIs, statins, thiazides, and warfarin.

Comparator

Participants with the same condition not taking the respective guideline recommended drug.

Outcome

Death (mortality) over 3 years of follow-up.hard clinical

Cardiovascular guideline-recommended drugs are associated with reduced mortality in older adults with multiple chronic conditions, though effects may vary based on specific combinations of comorbidities.

Cite This Study

Tinetti et al. (2015) studied this question.

synapsesocial.com/papers/6a73dbb5f4f9256fee8de910 https://doi.org/10.1136/bmj.h4984

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Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider