Key result
Medication underuse in older CVD patients is linked to ~152% higher non-CV mortality but not CV events.
Why the study?
Underutilization of beneficial cardiovascular drugs in older patients is common, but prevalence estimates, predictors, and clinical consequences are not well characterized.
Does medication underuse affect cardiovascular events and non-cardiovascular deaths in aging outpatients with cardiovascular disease?
Cohort (n=1,454)
Does medication underuse affect cardiovascular events and non-cardiovascular deaths in aging outpatients with cardiovascular disease?
Hazard Ratio: 1 (95% CI 0.65–1.56)
p-value: p=0.99
In older outpatients with cardiovascular disease, medication underuse is common and associated with frailty and non-cardiovascular death, but not with cardiovascular events.
Medication underuse signals frailty and competing non-CV risks without excess CV events; leaves open whether interventions improve outcomes in frail older adults.
BACKGROUND: Cardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated. METHODS: Using data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START). RESULTS: Medication underuse was present in 69.1% of 1454 included participants (mean age 71.1 ± 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m2), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]). CONCLUSION: Medication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
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Meid et al. (2015) conducted a cohort in Cardiovascular disease (n=1,454). Medication underuse vs. Appropriate medication use was evaluated on Cardiovascular events (fatal and non-fatal) (HR 1.00, 95% CI 0.65-1.56, p=0.99). Medication underuse in older outpatients with cardiovascular disease was not associated with cardiovascular events (HR 1.00) but was significantly associated with non-cardiovascular deaths (HR 2.52).
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