Is there room for deprescribing? The SHELTER Study

Prevalence of Preventive Cardiovascular Medication Use In nursing Home Residents

Alireza Malek Makan, Hein van Houdt, Graziano Onder, Rob van Marum

De abstractcommissie heeft op verzoek van de congrescommissie 9 abstracts geselecteerd die tijdens het Verenso najaarscongres 'Kiezen voor delen' op 24 november 2016 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Introduction

In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable.

Objective

To assess the prevalence of  four classes of preventive cardiovascular medication (PCM) in nursing home residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment and functional disability across countries.

Methods

A 12 months prospective cohort study was conducted in 57 NH in 8 countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands, and Israel). We assessed the prevalence at first measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet aggregation inhibitor (PAI), antihypertensive (AHT), and lipid modifying agent (LMA), in older (60+) residents with valid medication assessments. The PCM prevalence was compared across the length of stay (short <60 days, mid, long >12 months), health instability as defined by CHESS>3 (Changes in Health, End-Stage Disease, Signs, and Symptoms Scale), cognitive impairment by CPS>2 (cognitive performance scale) and ADLH>=5 (Functional disability was measured using the Activities of Daily Living (ADL) Hierarchy scale).   

Results

Of the 3759 eligible residents, 2175 (57.9%) used at least 1 or more PCMs. The prevalence of the four groups of PCM: OAC, PAI, AHT and LMA were 5.6%, 34.9%, 35.7%, and 10.4% respectively. PCM use was lower in long stay residents versus mid stay: 56.0% vs. 62.7%, in cognitively impaired residents (47.1% vs. 67%), in residents with a high mortality risk (47.4% vs. 58.6%) and in residents with a high ADLH score (48.6% vs 64.0%).  

Conclusion

Althoughthe prevalence of PCM use was lower in long stay, cognitively impaired residents, persons with a high mortality risk, and residents with more functional disabilities, there seems to be room for deprescribing.

Keywords

Cardiovascular disease, medication, Cognitive impairment, Nursing home resident, Shelter study.