Antihypertensive Deprescribing in Older Adult Veterans at End of Life Admitted to Veteran Affairs Nursing Homes
Published by Elsevier Inc..
OBJECTIVES: Geriatric palliative care approaches support deprescribing of antihypertensives in older nursing home (NH) residents with limited life expectancy and/or advanced dementia (LLE/AD) who are intensely treated for hypertension (HTN), but information on real-world deprescribing patterns in this population is limited. We examined the incidence and factors associated with antihypertensive deprescribing.
DESIGN: National, retrospective cohort study.
SETTING AND PARTICIPANTS: Older Veterans with LLE/AD and HTN admitted to VA NHs in fiscal years 2009-2015 with potential overtreatment of HTN at admission, defined as receiving at least 1 antihypertensive class of medications and mean daily systolic blood pressure (SBP) <120 mm Hg.
MEASURES: Deprescribing was defined as subsequent dose reduction or discontinuation of an antihypertensive for ≥7 days. Competing risk models assessed cumulative incidence and factors associated with deprescribing.
RESULTS: Within our sample (n = 10,574), cumulative incidence of deprescribing at 30 days was 41%. Veterans with the greatest level of overtreatment (ie, multiple antihypertensives and SBP <100 mm Hg) had an increased likelihood (hazard ratio 1.75, 95% confidence interval 1.59, 1.93) of deprescribing vs those with the lowest level of overtreatment (ie, one antihypertensive and SBP ≥100 to <120 mm Hg). Several markers of poor prognosis (ie, recent weight loss, poor appetite, dehydration, dependence for activities of daily living, pain) and later admission year were associated with increased likelihood of deprescribing, whereas cardiovascular risk factors (ie, diabetes, congestive heart failure, obesity), shortness of breath, and admission source from another NH or home/assisted living setting (vs acute hospital) were associated with decreased likelihood.
CONCLUSIONS AND IMPLICATIONS: Real-world deprescribing patterns of antihypertensives among NH residents with HTN and LLE/AD appear to reflect variation in recommendations for HTN treatment intensity and individualization of patient care in a population with potential overtreatment. Factors facilitating deprescribing included treatment intensity and markers of poor prognosis. Comparative effectiveness and safety studies are needed to guide clinical decisions around deprescribing and HTN management.
| Errataetall: |
ErratumIn: J Am Med Dir Assoc. 2021 Jun 8;:. - PMID 34115992 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
Journal of the American Medical Directors Association - 22(2021), 1 vom: 25. Jan., Seite 132-140.e5 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Vu, Michelle [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 30.06.2021 Date Revised 02.01.2022 published: Print-Electronic ErratumIn: J Am Med Dir Assoc. 2021 Jun 8;:. - PMID 34115992 Citation Status MEDLINE |
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| doi: |
10.1016/j.jamda.2020.05.060 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM312992742 |
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| 100 | 1 | |a Vu, Michelle |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Antihypertensive Deprescribing in Older Adult Veterans at End of Life Admitted to Veteran Affairs Nursing Homes |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 30.06.2021 | ||
| 500 | |a Date Revised 02.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: J Am Med Dir Assoc. 2021 Jun 8;:. - PMID 34115992 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by Elsevier Inc. | ||
| 520 | |a OBJECTIVES: Geriatric palliative care approaches support deprescribing of antihypertensives in older nursing home (NH) residents with limited life expectancy and/or advanced dementia (LLE/AD) who are intensely treated for hypertension (HTN), but information on real-world deprescribing patterns in this population is limited. We examined the incidence and factors associated with antihypertensive deprescribing | ||
| 520 | |a DESIGN: National, retrospective cohort study | ||
| 520 | |a SETTING AND PARTICIPANTS: Older Veterans with LLE/AD and HTN admitted to VA NHs in fiscal years 2009-2015 with potential overtreatment of HTN at admission, defined as receiving at least 1 antihypertensive class of medications and mean daily systolic blood pressure (SBP) <120 mm Hg | ||
| 520 | |a MEASURES: Deprescribing was defined as subsequent dose reduction or discontinuation of an antihypertensive for ≥7 days. Competing risk models assessed cumulative incidence and factors associated with deprescribing | ||
| 520 | |a RESULTS: Within our sample (n = 10,574), cumulative incidence of deprescribing at 30 days was 41%. Veterans with the greatest level of overtreatment (ie, multiple antihypertensives and SBP <100 mm Hg) had an increased likelihood (hazard ratio 1.75, 95% confidence interval 1.59, 1.93) of deprescribing vs those with the lowest level of overtreatment (ie, one antihypertensive and SBP ≥100 to <120 mm Hg). Several markers of poor prognosis (ie, recent weight loss, poor appetite, dehydration, dependence for activities of daily living, pain) and later admission year were associated with increased likelihood of deprescribing, whereas cardiovascular risk factors (ie, diabetes, congestive heart failure, obesity), shortness of breath, and admission source from another NH or home/assisted living setting (vs acute hospital) were associated with decreased likelihood | ||
| 520 | |a CONCLUSIONS AND IMPLICATIONS: Real-world deprescribing patterns of antihypertensives among NH residents with HTN and LLE/AD appear to reflect variation in recommendations for HTN treatment intensity and individualization of patient care in a population with potential overtreatment. Factors facilitating deprescribing included treatment intensity and markers of poor prognosis. Comparative effectiveness and safety studies are needed to guide clinical decisions around deprescribing and HTN management | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a Hypertension | |
| 650 | 4 | |a antihypertensives | |
| 650 | 4 | |a deprescribing | |
| 650 | 4 | |a end-of-life | |
| 650 | 4 | |a nursing homes | |
| 650 | 4 | |a older adults | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 700 | 1 | |a Sileanu, Florentina E |e verfasserin |4 aut | |
| 700 | 1 | |a Aspinall, Sherrie L |e verfasserin |4 aut | |
| 700 | 1 | |a Niznik, Joshua D |e verfasserin |4 aut | |
| 700 | 1 | |a Springer, Sydney P |e verfasserin |4 aut | |
| 700 | 1 | |a Mor, Maria K |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, Xinhua |e verfasserin |4 aut | |
| 700 | 1 | |a Ersek, Mary |e verfasserin |4 aut | |
| 700 | 1 | |a Hanlon, Joseph T |e verfasserin |4 aut | |
| 700 | 1 | |a Gellad, Walid F |e verfasserin |4 aut | |
| 700 | 1 | |a Schleiden, Loren J |e verfasserin |4 aut | |
| 700 | 1 | |a Thorpe, Joshua M |e verfasserin |4 aut | |
| 700 | 1 | |a Thorpe, Carolyn T |e verfasserin |4 aut | |
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