Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population
BackgroundStatin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential benefits against potential side effects, drug-drug interactions, and limited life expectancy.AimTo asse...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1236547/full |
| _version_ | 1797678678777266176 |
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| author | Luise Adam Luise Adam Luise Adam Oliver Baretella Oliver Baretella Martin Feller Martin Feller Manuel Raphael Blum Manuel Raphael Blum Dimitrios David Papazoglou Benoit Boland Benoit Boland Drahomir Aujesky Stéphanie Baggio Stéphanie Baggio Nicolas Rodondi Nicolas Rodondi |
| author_facet | Luise Adam Luise Adam Luise Adam Oliver Baretella Oliver Baretella Martin Feller Martin Feller Manuel Raphael Blum Manuel Raphael Blum Dimitrios David Papazoglou Benoit Boland Benoit Boland Drahomir Aujesky Stéphanie Baggio Stéphanie Baggio Nicolas Rodondi Nicolas Rodondi |
| author_sort | Luise Adam |
| collection | DOAJ |
| description | BackgroundStatin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential benefits against potential side effects, drug-drug interactions, and limited life expectancy.AimTo assess the prevalence and determinants of potentially inappropriate statin therapy in multimorbid older patients.MethodsWe conducted a cross-sectional analysis of patients aged ≥70 years with multimorbidity and polypharmacy in the Swiss study center of OPERAM, a cluster-randomized trial on pharmacotherapy optimization to reduce drug-related hospital admissions. We assessed potential underuse (no statin but formal indication) and potential overuse (statin but no formal indication, including predicted >60% one-year mortality based on the Walter Score) based on current guidelines for patients in secondary and primary cardiovascular prevention. We assessed the association of potential statin overuse and underuse with six patient characteristics (age, gender, number of diagnoses, number of medications, mental impairment, being housebound) in LASSO-selection analyses.ResultsOf 715 multimorbid older adults (79.7 ± 6.5 years, 39.9% women), 337 (47%) were on statin. Statin therapy was appropriate in 474 (66.3%), underused in 130 (18.2%), and overused in 111 (15.5%) patients. In participants in secondary cardiovascular prevention (n = 437), being female (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.67–4.22) was significantly associated with potential underuse while being housebound (OR 3.53, 95%CI 1.32–9.46) and taking ≥10 medications (OR 1.95,95%CI 1.05–3.67) were associated with potential overuse. In participants in primary cardiovascular prevention (n = 278), 28.1% were potentially under- (9%) or overusing (19%) a statin, with no identified risk factor.ConclusionA third of hospitalized multimorbid older patients with polypharmacy potentially (either) overused or underused statin therapy. Among patients in secondary cardiovascular prevention, women were at risk for potential statin underuse. Housebound patients and those taking ≥10 medications were at risk for potential overuse of a statin. Physicians should carefully evaluate the indication for statin prescription in multimorbid older patients with polypharmacy. |
| first_indexed | 2024-03-11T23:03:24Z |
| format | Article |
| id | doaj.art-3376012ae416418686c1dd07e133c8d1 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-11T23:03:24Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-3376012ae416418686c1dd07e133c8d12023-09-21T14:08:54ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-09-011010.3389/fcvm.2023.12365471236547Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial populationLuise Adam0Luise Adam1Luise Adam2Oliver Baretella3Oliver Baretella4Martin Feller5Martin Feller6Manuel Raphael Blum7Manuel Raphael Blum8Dimitrios David Papazoglou9Benoit Boland10Benoit Boland11Drahomir Aujesky12Stéphanie Baggio13Stéphanie Baggio14Nicolas Rodondi15Nicolas Rodondi16Institute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDivision of Angiology, Gefässzentrum, Kantonsspital Baden, Baden, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandGeriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, BelgiumHealth Science Research Institute, UCLouvain, Louvain, BelgiumDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandPopulation Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandBackgroundStatin therapy in multimorbid older individuals with polypharmacy is controversial, particularly in primary prevention of cardiovascular disease. Thereby, physicians must weigh potential benefits against potential side effects, drug-drug interactions, and limited life expectancy.AimTo assess the prevalence and determinants of potentially inappropriate statin therapy in multimorbid older patients.MethodsWe conducted a cross-sectional analysis of patients aged ≥70 years with multimorbidity and polypharmacy in the Swiss study center of OPERAM, a cluster-randomized trial on pharmacotherapy optimization to reduce drug-related hospital admissions. We assessed potential underuse (no statin but formal indication) and potential overuse (statin but no formal indication, including predicted >60% one-year mortality based on the Walter Score) based on current guidelines for patients in secondary and primary cardiovascular prevention. We assessed the association of potential statin overuse and underuse with six patient characteristics (age, gender, number of diagnoses, number of medications, mental impairment, being housebound) in LASSO-selection analyses.ResultsOf 715 multimorbid older adults (79.7 ± 6.5 years, 39.9% women), 337 (47%) were on statin. Statin therapy was appropriate in 474 (66.3%), underused in 130 (18.2%), and overused in 111 (15.5%) patients. In participants in secondary cardiovascular prevention (n = 437), being female (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.67–4.22) was significantly associated with potential underuse while being housebound (OR 3.53, 95%CI 1.32–9.46) and taking ≥10 medications (OR 1.95,95%CI 1.05–3.67) were associated with potential overuse. In participants in primary cardiovascular prevention (n = 278), 28.1% were potentially under- (9%) or overusing (19%) a statin, with no identified risk factor.ConclusionA third of hospitalized multimorbid older patients with polypharmacy potentially (either) overused or underused statin therapy. Among patients in secondary cardiovascular prevention, women were at risk for potential statin underuse. Housebound patients and those taking ≥10 medications were at risk for potential overuse of a statin. Physicians should carefully evaluate the indication for statin prescription in multimorbid older patients with polypharmacy.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1236547/fullpolypharmacymultimorbiditycardiovascular preventionstatin-guideline adherence |
| spellingShingle | Luise Adam Luise Adam Luise Adam Oliver Baretella Oliver Baretella Martin Feller Martin Feller Manuel Raphael Blum Manuel Raphael Blum Dimitrios David Papazoglou Benoit Boland Benoit Boland Drahomir Aujesky Stéphanie Baggio Stéphanie Baggio Nicolas Rodondi Nicolas Rodondi Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population Frontiers in Cardiovascular Medicine polypharmacy multimorbidity cardiovascular prevention statin -guideline adherence |
| title | Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population |
| title_full | Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population |
| title_fullStr | Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population |
| title_full_unstemmed | Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population |
| title_short | Statin therapy in multimorbid older patients with polypharmacy- a cross-sectional analysis of the Swiss OPERAM trial population |
| title_sort | statin therapy in multimorbid older patients with polypharmacy a cross sectional analysis of the swiss operam trial population |
| topic | polypharmacy multimorbidity cardiovascular prevention statin -guideline adherence |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1236547/full |
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