TY - JOUR
T1 - Prescribing, deprescribing and potential adverse effects of proton pump inhibitors in older patients with multimorbidity
T2 - an observational study
AU - Aubert, Carole E
AU - Blum, Manuel R
AU - Gastens, Viktoria
AU - Dalleur, Olivia
AU - Vaillant, Fanny
AU - Jennings, Emma
AU - Aujesky, Drahomir
AU - Thompson, Wade
AU - Kool, Tijn
AU - Kramers, Cornelius
AU - Knol, Wilma
AU - O'Mahony, Denis
AU - Rodondi, Nicolas
N1 - Publisher Copyright:
© 2023 CMA Impact Inc. or its licensors.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - BACKGROUND: Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population.METHODS: We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016-2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission.RESULTS: Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission (
n = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12-1.53).
INTERPRETATION: Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population.
AB - BACKGROUND: Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population.METHODS: We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016-2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission.RESULTS: Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission (
n = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12-1.53).
INTERPRETATION: Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population.
KW - Aged
KW - Aged, 80 and over
KW - Deprescriptions
KW - Humans
KW - Longitudinal Studies
KW - Multimorbidity
KW - Prospective Studies
KW - Proton Pump Inhibitors/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85149153170&partnerID=8YFLogxK
U2 - 10.9778/cmajo.20210240
DO - 10.9778/cmajo.20210240
M3 - Article
C2 - 36854455
SN - 2291-0026
VL - 11
SP - E170-E178
JO - CMAJ open
JF - CMAJ open
IS - 1
ER -