Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services

Korhonen, Maarit Jaana; Ilomäki, Jenni; Sluggett, Janet K.; Brookhart, M. Alan; Visvanathan, Renuka; Cooper, Tina; Robson, Leonie; Bell, John

doi:10.1016/j.jacl.2018.02.012

Cited by 17 publications

(29 citation statements)

References 47 publications

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“…Direct-acting oral anticoagulants were not identified in this study; however, future studies should investigate the impact of these medications on the prescribing of warfarin and other anticoagulants. Although statin use in NHs increased over time points, its use remains low in comparison with recent findings internationally in Australian [8,41], Canadian [42] and European [3] NHs, which found a prevalence of up to 40%. A review of randomized controlled trials (RCTs) and retrospective studies of statin use for secondary prevention in community-dwelling older people identified overall benefit in reduction of cardiovascular events and mortality in those aged ≥ 65 to < 75 years but minimal justification for its use in those aged > 85 years [43].…”

Section: Discussioncontrasting

confidence: 58%

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

et al. 2019

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Background One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time.Objective The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. Methods Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. Results Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 in NHs and 2007 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. Conclusions The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.

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Section: Discussioncontrasting

confidence: 58%

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

et al. 2019

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“…Prior observational evidence along these lines has been inconsistent. A prospective cohort study of 383 residents aged ≥65 years found that the risk of mortality, all-cause hospitalizations, and incidence of falls during the 12-month follow-up were lower among statin users than non-users [43]. In contrast, an observational study of statin use and incident frailty in women aged 65 years old or older failed to observe associations between current statin use, duration and potency of statin use and incident frailty [30].…”

Section: Discussionmentioning

confidence: 99%

Genetically-predicted life-long lowering of low-density lipoprotein cholesterol is associated with decreased frailty: A Mendelian randomization study in UK biobank

Wang

Lehto

et al. 2019

EBioMedicine

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Background High circulating low-density lipoprotein cholesterol (LDL-C) is a major risk factor for atherosclerosis and age-associated cardiovascular events. Long-term dyslipidaemia could contribute to the development of frailty in older individuals through its role in determining cardiovascular health and potentially other physiological pathways. Methods We conducted Mendelian randomization (MR) analyses using genetic variants to estimate the effects of long-term LDL-C modification on frailty in UK Biobank ( n = 378,161). Frailty was derived from health questionnaire and interview responses at baseline when participants were aged 40 to 69 years, and calculated using an accumulation-of-deficits approach, i.e. the frailty index (FI). Several aggregated instrumental variables (IVs) using 50 and 274 genetic variants were constructed from independent single-nucleotide polymorphisms (SNPs) to instrument circulating LDL-C concentrations. Specific sets of variants in or near genes that encode six lipid-lowering drug targets ( HMGCR , PCSK9 , NPC1L1 , APOB , APOC3 , and LDLR ) were used to index effects of exposure to related drug classes on frailty. SNP-LDL-C effects were available from previously published studies. SNP-FI effects were obtained using adjusted linear regression models. Two-sample MR analyses were performed with the IVs as instruments using inverse-variance weighted, MR-Egger, weighted median, and weighted mode methods. To address the stability of the findings, MR analyses were also performed using i) a modified FI excluding the cardiometabolic deficit items and ii) data from comparatively older individuals (aged ≥60 years) only. Several sensitivity analyses were also conducted. Findings On average 0.14% to 0.23% and 0.16% to 0.31% decrements in frailty were observed per standard deviation reduction in LDL-C exposure, instrumented by the general IVs consisting of 50 and 274 variants, respectively. Consistent, though less precise, associations were observed in the HMGCR -, APOC3 -, NPC1L1 -, and LDLR -specific IV analyses. In contrast, results for PCSK9 were in the same direction but more modest, and null for APOB . All sensitivity analyses produced similar findings. Interpretation A genetically-predicted life-long lowering of LDL-C is associated with decreased frailty in midlife and older age, representing supportive evidence for LDL-C's role in multiple health- and age-related pathways. The use of lipid-lowering therapeutics with varying mechanisms of action may differ by the extent to which they provide overall health benefits.

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“…Aged care services are synonymous with long-term care facilities or nursing homes (Australian Institute of Health and Welfare, 2018; Sluggett et al, 2017). The cohort and data collection process have been described previously (Korhonen et al, 2018; Lalic et al, 2016; Tan et al, 2014). In brief, baseline data were collected from April to August 2014 by three trained study nurses.…”

Section: Methodsmentioning

confidence: 99%

“…The rate of falls is up to three times higher among residents of aged care services compared with community-dwelling older people (Older People and Dementia, 2009; Rubenstein et al, 1994). A recent Australian study found that the median number of falls was three per person-year across six aged care services and 11% ( n = 44) of the sample were hospitalized due to falls or fall-related injuries over a 12-month period (Korhonen et al, 2018). Falls and fall-related injuries account for more than one quarter of hospitalizations from Australian aged care services (Lalic et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

et al. 2019

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Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.

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Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services

Cited by 17 publications

References 47 publications

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities

Genetically-predicted life-long lowering of low-density lipoprotein cholesterol is associated with decreased frailty: A Mendelian randomization study in UK biobank

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

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