Variability in the prescription of cardiovascular medications in older patients: correlates and potential explanations.
In western countries approximately a quarter of the population is 65 years and older. People in this age group often have several coexisting medical problems and take multiple drugs, and older people receive the greatest proportion of dispensed prescriptions. The prevalence of cardiovascular diseases, the leading cause of death and a major cause of physical and cognitive disability, increases steeply with increasing age. Drugs for the prevention and treatment of cardiovascular conditions account for a large proportion of medication prescription in older persons. Despite a number of published guidelines and expert recommendations supporting a standardized use of many cardiovascular agents, there is growing evidence of a tremendous variability in cardiovascular drug prescriptions according to demographics, health characteristics, and setting of care. In particular, evidence shows an inverse relationship between treatment propensity and age. To date, there is little evidence of benefit of most pharmacotherapy in frail, older subjects or elderly individuals with multiple comorbidities and polypharmacotherapy. However, effective treatment should not be denied solely on the basis of age. A major challenge in geriatric practice is to ensure safe and effective pharmacological treatments, avoiding the risk of polypharmacy and inappropriate drug prescription.
Internal Medicine Department, S. Anna Hospital, Ferrara, Italy. mrlcnz@unife.it
Cinzia
C
Maraldi
Fabrizia
F
Lattanzio
Graziano
G
Onder
Massimo
M
Gallerani
Silvia
S
Bustacchini
Giuseppe
G
De Tommaso
Stefano
S
Volpato
D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006074:Gout Suppressants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors