Abstract 20002: Potentially Inappropriate Medication Use in Older Patients With Coronary Heart Disease: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: Potentially inappropriate medication (PIM) use is common among the elderly. The prevalence of PIM use in patients with coronary heart disease (CHD) and its association with outcome is unknown. This study assesses the prevalence of PIM use over time in CHD patients and examines the association with mortality.
Methods: We identified 1,428 patients with CHD from the Atherosclerosis Risk in Communities (ARIC) study, a biracial longitudinal cohort study in four U.S. communities, using ICD-9 codes from hospitalizations. Using the 2015 Updated Beers Criteria, PIMs were categorized as unconditional or conditional based on dose/disease. PIM use was defined as having at least one Medicare Part D claim from 2006-2013. High volume PIMs were further categorized into pharmacological classes. The prevalence of PIMs was calculated as the number of PIM-using months divided by total months at risk. Discrete time hazard models assessed associations between current or historical PIM use and short-term mortality. Models were adjusted for sociodemographic factors and comorbidities using the Charlson Comorbidity Index.
Results: In CHD patients, 98% filled at least one PIM prescription over the study period, 59% for an unconditional PIM. The most commonly prescribed PIMs (Figure) were diuretics and proton pump inhibitors (PPIs). Overall PIM use remained relatively stable except for PPIs (16% to 24% increase) and opioids (13% to 7% decline). Across PIM classes, we found no evidence of a deleterious association with short-term mortality with the exception of opioids and antipsychotics (Odds Ratio: 1.95; 95% CI [1.50 - 2.53] and 2.30 [1.35 - 3.92], respectively).
Conclusion: In patients with CHD, PIM use was substantial. Short-term use of opioids and antipsychotics was associated with a poor outcome. While the short-term effect on mortality does not appear to be harmful in other classes, the long-term impact warrants further investigation.
Author Disclosures: A. Aldemerdash: None. J.S. Rotter: None. K. Alburikan: None. R.H. Tran: None. J.K. Asafu-Adjei: None. S.C. Stearns: None. C.A. Sueta: None. J.E. Rodgers: None.
- © 2016 by American Heart Association, Inc.