Associations of guideline recommended medications for acute coronary syndromes with fall-related hospitalizations and cardiovascular events in older women with ischemic heart disease

Peeters, Geeske, Tett, Susan E., Hollingworth, Samantha A., Gnjidic, Danijela, Hilmer, Sarah N., Dobson, Annette J. and Hubbard, Ruth E. (2016) Associations of guideline recommended medications for acute coronary syndromes with fall-related hospitalizations and cardiovascular events in older women with ischemic heart disease. Journals of Gerontology - Series A: Biological Sciences and Medical Sciences, . doi:doi:10.1093/gerona/glw111


Author Peeters, Geeske
Tett, Susan E.
Hollingworth, Samantha A.
Gnjidic, Danijela
Hilmer, Sarah N.
Dobson, Annette J.
Hubbard, Ruth E.
Title Associations of guideline recommended medications for acute coronary syndromes with fall-related hospitalizations and cardiovascular events in older women with ischemic heart disease
Journal name Journals of Gerontology - Series A: Biological Sciences and Medical Sciences   Check publisher's open access policy
ISSN 1758-535X
1079-5006
Publication date 2016-07-06
Sub-type Article (original research)
DOI doi:10.1093/gerona/glw111
Open Access Status Not Open Access
Total pages 7
Place of publication Cary, NC, United States
Publisher Oxford University Press
Collection year 2017
Language eng
Formatted abstract
Background: Guidelines for acute coronary syndrome recommend statins, β-blockers, angiotensin-converting-enzyme inhibitors or renin-angiotensin system blockers, and antiplatelet agents for the secondary prevention of cardiovascular events. The aim was to examine associations between guideline recommended medications and fall-related hospitalizations and cardiovascular events in robust and frail older women.

Methods: 2002–2011 surveys from the Australian Longitudinal Study on Women’s Health linked with administrative hospital, pharmaceutical and death registry data (2003–mid-2011) were used. Eight hundred eighty-five women (82.7±2.7 years, range 76–90) had prior admission for ischemic heart disease and ≥1 claims for any of the four medication classes. Four hundred thirteen (46.7%) were robust and 472 (53.3%) were frail. Fall-related admissions; cardiovascular event-related admissions or death; and cardiovascular death were recorded. Associations between each of the exposures and outcomes were analyzed using survival analyses with noncardiovascular death as a competing risk.

Results: There were 192 fall-related admissions and 314 cardiovascular events including 82 deaths. Using four recommended classes (compared to using one) was associated with increased risks of fall-related admissions (hazard ratio [HR] = 2.57, 95% confidence interval [CI] = 1.24–5.33), but not with cardiovascular events (HR = 1.41, CI = 0.97–2.05) or cardiovascular death (HR = 0.68, CI = 0.35–1.34). Associations for fall-related admissions were stronger in frail participants (HR = 5.46, CI = 1.34–22.30) than robust (HR = 1.37, CI = 0.48–3.95).

Conclusions: In older women with ischemic heart disease, the combination of the four recommended medication classes was associated with increased risk of falls, particularly among frail women, with no statistically significant gain in cardiovascular health. The risks of falls and consequential morbidity in women over 75 needs consideration when prescribing medications after myocardial infarction.
Keyword Pharmaceutical therapy
Ischemic heart disease
Statin
Beta-blocker
Accidental falls
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Published online 6 July 2016

 
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Created: Fri, 08 Jul 2016, 14:15:36 EST by Ms Felicity Lindberg on behalf of School of Pharmacy