Danijela Gnjidic1, Alexander Bennett2, David G Le Couteur3, Fiona M Blyth4, Robert G Cumming5, Louise Waite6, David Handelsman7, Vasi Naganathan4, Slade Matthews8, Sarah N Hilmer2. 1. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia. Electronic address: danijela.gnjidic@sydney.edu.au. 2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia. 3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia; ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia. 4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia. 5. Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 6. Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia. 7. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia. 8. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Discipline of Pharmacology, University of Sydney, Sydney, NSW, Australia.
Abstract
BACKGROUND: Guideline recommended management of ischemic heart disease (IHD) suggests the concomitant use of antiplatelet, beta-blocker, renin angiotensin system blocker and statin therapy. In older people exposure to multiple medications has been associated with adverse events and geriatric syndromes. The study aimed to investigate the use of medications for IHD in older men with and without geriatric syndromes, and whether adherence to medication guidelines impacts on adverse outcomes. METHODS: Community-dwelling men, aged ≥ 70 years and enrolled in the Concord Health and Ageing in Men Project were studied. Data on self-reported IHD, number of guideline recommended medications (use of four guideline medications considered optimal medical therapy) and geriatric syndromes (frailty, falls, cognitive impairment and urinary incontinence) were obtained. Cox regression was used to assess the relationship between optimal medical therapy and adverse outcomes (mortality and institutionalization), stratifying by geriatric syndromes. RESULTS: At baseline, 462 (27%) men self-reported a history of IHD and of these, 226 (49%) had at least one geriatric syndrome. Among men with IHD, no significant difference was observed in patterns of prescribing between those with and without geriatric syndromes. Compared to zero medications, optimal medical therapy among men with IHD was associated with lower mortality [hazard ratio, HR = 0.40 (95% CI: 0.21-0.95)] and institutionalization risk (HR=0.31; 95% CI: 0.09-0.81). The presence of geriatric syndromes did not modify the association of increasing use of guideline recommended medications and clinical outcomes. CONCLUSION: In older men with IHD, greater adherence to medication guidelines appears to be positively associated with better clinical outcomes, independent of geriatric syndromes.
BACKGROUND: Guideline recommended management of ischemic heart disease (IHD) suggests the concomitant use of antiplatelet, beta-blocker, renin angiotensin system blocker and statin therapy. In older people exposure to multiple medications has been associated with adverse events and geriatric syndromes. The study aimed to investigate the use of medications for IHD in older men with and without geriatric syndromes, and whether adherence to medication guidelines impacts on adverse outcomes. METHODS: Community-dwelling men, aged ≥ 70 years and enrolled in the Concord Health and Ageing in Men Project were studied. Data on self-reported IHD, number of guideline recommended medications (use of four guideline medications considered optimal medical therapy) and geriatric syndromes (frailty, falls, cognitive impairment and urinary incontinence) were obtained. Cox regression was used to assess the relationship between optimal medical therapy and adverse outcomes (mortality and institutionalization), stratifying by geriatric syndromes. RESULTS: At baseline, 462 (27%) men self-reported a history of IHD and of these, 226 (49%) had at least one geriatric syndrome. Among men with IHD, no significant difference was observed in patterns of prescribing between those with and without geriatric syndromes. Compared to zero medications, optimal medical therapy among men with IHD was associated with lower mortality [hazard ratio, HR = 0.40 (95% CI: 0.21-0.95)] and institutionalization risk (HR=0.31; 95% CI: 0.09-0.81). The presence of geriatric syndromes did not modify the association of increasing use of guideline recommended medications and clinical outcomes. CONCLUSION: In older men with IHD, greater adherence to medication guidelines appears to be positively associated with better clinical outcomes, independent of geriatric syndromes.
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