Cargando…

Deprescribing in cardiometabolic conditions in older patients: a systematic review

We conduct a systematic review to investigate current deprescribing practices and evaluate outcomes and adverse events with deprescribing of preventive medications in older patients with either an end-of-life designation or residing in long-term care facilities with cardiometabolic conditions. Studi...

Descripción completa

Detalles Bibliográficos
Autores principales: Hickman, Elizabeth, Seawoodharry, Mansha, Gillies, Clare, Khunti, Kamlesh, Seidu, Samuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643631/
https://www.ncbi.nlm.nih.gov/pubmed/37402905
http://dx.doi.org/10.1007/s11357-023-00852-z
_version_ 1785147142587809792
author Hickman, Elizabeth
Seawoodharry, Mansha
Gillies, Clare
Khunti, Kamlesh
Seidu, Samuel
author_facet Hickman, Elizabeth
Seawoodharry, Mansha
Gillies, Clare
Khunti, Kamlesh
Seidu, Samuel
author_sort Hickman, Elizabeth
collection PubMed
description We conduct a systematic review to investigate current deprescribing practices and evaluate outcomes and adverse events with deprescribing of preventive medications in older patients with either an end-of-life designation or residing in long-term care facilities with cardiometabolic conditions. Studies were identified using a literature search of MEDLINE, EMBASE, Web of Science, clinicaltrials.gov.uk, CINAHLS, and the Cochrane Register from inception to March 2022. Studies reviewed included observational studies and randomised control trials (RCTs). Data was extracted on baseline characteristics, deprescribing rates, adverse events and outcomes, and quality of life indicators, and was discussed using a narrative approach. Thirteen studies were identified for inclusion. Deprescribing approaches included complete withdrawal, dose reduction or tapering, or switching to an alternative medication, for at least one preventive medication. Deprescribing success rates ranged from 27 to 94.7%. The studies reported no significant changes in laboratory values or adverse outcomes but did find mixed outcomes for hospitalisations and a slight increase in mortality rates when comparing the intervention and control groups. Lack of good-quality randomised control trials suggests that deprescribing in the older population residing in long-term care facilities with cardiometabolic conditions and multimorbidity is feasible when controlled and regularly monitored by an appropriate healthcare clinician, and that the benefits outweigh the potential harm in this cohort of patients. Due to the limited evidence and the heterogeneity of studies, a meta-analysis was not performed and as such further research is required to assess the benefits of deprescribing in this patient population. Systematic review registration: PROSPERO CRD42021291061. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11357-023-00852-z.
format Online
Article
Text
id pubmed-10643631
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-106436312023-11-15 Deprescribing in cardiometabolic conditions in older patients: a systematic review Hickman, Elizabeth Seawoodharry, Mansha Gillies, Clare Khunti, Kamlesh Seidu, Samuel GeroScience Review We conduct a systematic review to investigate current deprescribing practices and evaluate outcomes and adverse events with deprescribing of preventive medications in older patients with either an end-of-life designation or residing in long-term care facilities with cardiometabolic conditions. Studies were identified using a literature search of MEDLINE, EMBASE, Web of Science, clinicaltrials.gov.uk, CINAHLS, and the Cochrane Register from inception to March 2022. Studies reviewed included observational studies and randomised control trials (RCTs). Data was extracted on baseline characteristics, deprescribing rates, adverse events and outcomes, and quality of life indicators, and was discussed using a narrative approach. Thirteen studies were identified for inclusion. Deprescribing approaches included complete withdrawal, dose reduction or tapering, or switching to an alternative medication, for at least one preventive medication. Deprescribing success rates ranged from 27 to 94.7%. The studies reported no significant changes in laboratory values or adverse outcomes but did find mixed outcomes for hospitalisations and a slight increase in mortality rates when comparing the intervention and control groups. Lack of good-quality randomised control trials suggests that deprescribing in the older population residing in long-term care facilities with cardiometabolic conditions and multimorbidity is feasible when controlled and regularly monitored by an appropriate healthcare clinician, and that the benefits outweigh the potential harm in this cohort of patients. Due to the limited evidence and the heterogeneity of studies, a meta-analysis was not performed and as such further research is required to assess the benefits of deprescribing in this patient population. Systematic review registration: PROSPERO CRD42021291061. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11357-023-00852-z. Springer International Publishing 2023-07-05 /pmc/articles/PMC10643631/ /pubmed/37402905 http://dx.doi.org/10.1007/s11357-023-00852-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Hickman, Elizabeth
Seawoodharry, Mansha
Gillies, Clare
Khunti, Kamlesh
Seidu, Samuel
Deprescribing in cardiometabolic conditions in older patients: a systematic review
title Deprescribing in cardiometabolic conditions in older patients: a systematic review
title_full Deprescribing in cardiometabolic conditions in older patients: a systematic review
title_fullStr Deprescribing in cardiometabolic conditions in older patients: a systematic review
title_full_unstemmed Deprescribing in cardiometabolic conditions in older patients: a systematic review
title_short Deprescribing in cardiometabolic conditions in older patients: a systematic review
title_sort deprescribing in cardiometabolic conditions in older patients: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643631/
https://www.ncbi.nlm.nih.gov/pubmed/37402905
http://dx.doi.org/10.1007/s11357-023-00852-z
work_keys_str_mv AT hickmanelizabeth deprescribingincardiometabolicconditionsinolderpatientsasystematicreview
AT seawoodharrymansha deprescribingincardiometabolicconditionsinolderpatientsasystematicreview
AT gilliesclare deprescribingincardiometabolicconditionsinolderpatientsasystematicreview
AT khuntikamlesh deprescribingincardiometabolicconditionsinolderpatientsasystematicreview
AT seidusamuel deprescribingincardiometabolicconditionsinolderpatientsasystematicreview