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. 2020 Aug;11(4):239-246.
doi: 10.14740/cr1078. Epub 2020 Jun 3.

Association of Potentially Inappropriate Medications With All-Cause Mortality in the Elderly Acute Decompensated Heart Failure Patients: Importance of Nonsteroidal Anti-Inflammatory Drug Prescription

Tomiko Sunaga  1   2 , Azusa Yokoyama  2 , Shoko Nakamura  1 , Nagisa Miyamoto  2 , Saki Watanabe  3 , Miki Tsujiuchi  4 , Sakura Nagumo  4 , Ayaka Nogi  4 , Hideyuki Maezawa  4 , Takuya Mizukami  4 , Mio Ebato  4 , Hiroshi Suzuki  4 , Akihiro Nakamura  3 , Toru Watanabe  1   2 , Tadanori Sasaki  1
Affiliations

Association of Potentially Inappropriate Medications With All-Cause Mortality in the Elderly Acute Decompensated Heart Failure Patients: Importance of Nonsteroidal Anti-Inflammatory Drug Prescription

Tomiko Sunaga et al. Cardiol Res. 2020 Aug.

Abstract

Background: Acute decompensated heart failure (ADHF) is the most common cause of readmissions in the hospital. ADHF patients are associated with polypharmacy. It is a common problem among elderly patients due to frequently occurring multiple morbidities and is associated with the use of potentially inappropriate medications (PIMs). The aim of this study was to examine the association between PIMs and all-cause mortality in elderly ADHF patients.

Methods: This retrospective study included ADHF patients who were admitted to the Showa University Fujigaoka Hospital between January 2015 and August 2016. We investigated the proportion of patients taking at least one PIM at admission and the characteristics of patients at admission. PIMs were defined based on the Screening Tool of Older People's potentially inappropriate Prescriptions (STOPP). Multiple Cox regression analysis was performed to examine the association between PIM use and all-cause mortality.

Results: A total of 193 elderly patients (median age 81 years, interquartile range (IQR) 65 - 99 years) were included in the study. All-cause death occurred in 30 patients. The median number of medications at admission was 7 (IQR 0 - 18). The number of medications (greater than or equal to six) at admission was associated with mortality. Multivariate Cox regression analysis revealed that systolic blood pressure (SBP) < 100 mm Hg at admission, chronic obstructive pulmonary disease (COPD), and use of non-steroidal anti-inflammatory drugs (NSAIDs) at admission were independent predictors for all-cause mortality.

Conclusions: The medical staff should attempt to stop unnecessary medications that are prone to be inappropriate prescribing. In particular, prescription of NSAIDs should be carefully assessed and monitored.

Keywords: Elderly heart failure; Non-steroidal anti-inflammatory drugs; Potentially inappropriate medications; Prognosis; STOPP criteria.

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Conflict of interest statement

TM received personal fees from Heart Flow Inc. The other authors have no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier mortality curves according to non-steroidal anti-inflammatory drug use at admission.
Figure 2
Figure 2
Kaplan-Meier mortality curves according to polypharmacy at admission.
See this image and copyright information in PMC

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