Prescriptions for Potentially Inappropriate Medications from the Beers Criteria Among Older Adults Hospitalized for Heart Failure |
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| Affiliation: | 1. School of Medicine & Health Sciences, George Washington University, Washington, DC;2. Department of Medicine, Weill Cornell Medicine, New York, New York;3. School of Medicine, University of Colorado, Aurora, Colorado;4. Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas;5. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama;6. Department of Medicine, Columbia University Irving Medical Center, New York, New York;1. Advanced Heart Failure Program, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota;2. Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota;3. The Neuromuscular Cardiomyopathy Clinic, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota;1. NYU Grossman School of Medicine, Division of Medical Ethics, New York, New York;2. George Washington University, School of Nursing, Center for Health Policy and Media Engagement, Washington, DC;3. George Washington University, Milken Institute School of Public Health, Department of Health Policy and Management, Washington, DC;1. Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, Texas;2. Advanced Heart Failure & Cardiac Transplantation, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina;3. Division of Cardiology, Duke University Hospital/Duke Clinical Research Institute, Durham, North Carolina;4. Division of Cardiology, University of Minnesota, Minneapolis, Minnesota;5. Division of Cardiology, University of California, San Francisco, California;6. Division of Cardiology, Department of Advanced Heart Failure, Mechanical Support, and Transplant, Baylor Heart and Vascular Hospital, Dallas, Texas;7. Department of Medicine, University of California, San Francisco, California;1. Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA;2. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA;1. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA;2. Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy;3. Cardiomyopathy Unit, Heart, Lung and Vessels Department, Careggi University Hospital, Florence, Italy;4. Cardiovascular Research Foundation, New York, NY, USA |
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| Abstract: | BackgroundWe sought to better understand patterns of potentially inappropriate medications (PIMs) from the Beers criteria among older adults hospitalized with heart failure (HF). This observational study of hospitalizations was derived from the geographically diverse REasons for Geographic and Racial Differences in Stroke cohort.Methods and ResultsWe examined participants aged 65 years and older with an expert-adjudicated hospitalization for HF. The Beers criteria medications were abstracted from medical records. The prevalence of PIMs was 61.1% at admission and 64.0% at discharge. Participants were taking a median of 1 PIM (interquartile range [IQR] 0–1 PIM) at hospital admission and a median of 1 PIM (IQR 0–2 PIM) at hospital discharge. Between admission and discharge, 19.1% of patients experienced an increase in the number of PIMs, 15.1% experienced a decrease, and 37% remained on the same number between hospital admission and discharge. The medications with the greatest increase from admission to discharge were proton pump inhibitors (32.6% to 38.6%) and amiodarone (6.2% to 12.2%). The strongest determinant of potentially harmful prescribing patterns was polypharmacy (relative risk 1.34, 95% confidence interval 1.16–1.55, P < .001).ConclusionsPIMs are common among older adults hospitalized for HF and may be an important target to improve outcomes in this vulnerable population. |
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