Michelle C Odden1, Sei J Lee2, Michael A Steinman2, Anna D Rubinsky3, Laura Graham4, Bocheng Jing5, Kathy Fung5, Zachary A Marcum6, Carmen A Peralta7. 1. Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Geriatric Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA. Electronic address: modden@stanford.edu. 2. Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of Geriatrics, San Francisco VA Medical Center, San Francisco, CA, USA. 3. Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA. 4. Health Economics Research Center, VA Palo Alto Health Care System, Palo Alto, CA, USA. 5. Division of Geriatrics, San Francisco VA Medical Center, San Francisco, CA, USA. 6. Department of Pharmacy, University of Washington, Seattle, WA, USA. 7. Kidney Health Research Collaborative, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA; Cricket Health, Inc, San Francisco, CA, USA.
Abstract
OBJECTIVES: To evaluate the incidence of deprescribing of antihypertensive medication among older adults residing in Veterans Affairs (VA) nursing homes for long-term care and rates of deprescribing after potentially triggering events. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Long-term care residents aged 65 years and older admitted to a VA nursing home from 2006 to 2019 and using blood pressure medication at admission. METHODS: Data were extracted from the VA electronic health record, and Centers for Medicare & Medicaid Services Minimum Data Set and Bar Code Medication Administration. Deprescribing was defined on a rolling basis as a reduction in the number or dose of antihypertensive medications, sustained for ≥2 weeks. We examined potentially triggering events for deprescribing, including low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and falls. RESULTS: Among 31,499 VA nursing home residents on antihypertensive medication, 70.4% had ≥1 deprescribing event (median length of stay = 6 months), and 48.7% had a net reduction in antihypertensive medications over their stay. Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, a 50% increase in serum creatinine was associated with the greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: residents with this event had a 41.7% chance of being deprescribed compared with 11.5% in those who did not (risk difference = 30.3%, P < .001). A fall in the past 30 days was associated with the smallest magnitude increased risk of deprescribing (risk difference = 3.8%, P < .001) of the events considered. CONCLUSIONS AND IMPLICATIONS: Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event. Published by Elsevier Inc.
OBJECTIVES: To evaluate the incidence of deprescribing of antihypertensive medication among older adults residing in Veterans Affairs (VA) nursing homes for long-term care and rates of deprescribing after potentially triggering events. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Long-term care residents aged 65 years and older admitted to a VA nursing home from 2006 to 2019 and using blood pressure medication at admission. METHODS: Data were extracted from the VA electronic health record, and Centers for Medicare & Medicaid Services Minimum Data Set and Bar Code Medication Administration. Deprescribing was defined on a rolling basis as a reduction in the number or dose of antihypertensive medications, sustained for ≥2 weeks. We examined potentially triggering events for deprescribing, including low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and falls. RESULTS: Among 31,499 VA nursing home residents on antihypertensive medication, 70.4% had ≥1 deprescribing event (median length of stay = 6 months), and 48.7% had a net reduction in antihypertensive medications over their stay. Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, a 50% increase in serum creatinine was associated with the greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: residents with this event had a 41.7% chance of being deprescribed compared with 11.5% in those who did not (risk difference = 30.3%, P < .001). A fall in the past 30 days was associated with the smallest magnitude increased risk of deprescribing (risk difference = 3.8%, P < .001) of the events considered. CONCLUSIONS AND IMPLICATIONS: Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event. Published by Elsevier Inc.
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