title: Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: A population-based study.
abstract: BACKGROUND
  Guideline recommended management of ischemic heart disease (IHD) suggests the concomitant use of antiplatelet, beta-blocker, renin angiotensin system blocker and statin therapy. In older people exposure to multiple medications has been associated with adverse events and geriatric syndromes. The study aimed to investigate the use of medications for IHD in older men with and without geriatric syndromes, and whether adherence to medication guidelines impacts on adverse outcomes.
  
  
  METHODS
  Community-dwelling men, aged ≥ 70 years and enrolled in the Concord Health and Ageing in Men Project were studied. Data on self-reported IHD, number of guideline recommended medications (use of four guideline medications considered optimal medical therapy) and geriatric syndromes (frailty, falls, cognitive impairment and urinary incontinence) were obtained. Cox regression was used to assess the relationship between optimal medical therapy and adverse outcomes (mortality and institutionalization), stratifying by geriatric syndromes.
  
  
  RESULTS
  At baseline, 462 (27%) men self-reported a history of IHD and of these, 226 (49%) had at least one geriatric syndrome. Among men with IHD, no significant difference was observed in patterns of prescribing between those with and without geriatric syndromes. Compared to zero medications, optimal medical therapy among men with IHD was associated with lower mortality [hazard ratio, HR = 0.40 (95% CI: 0.21-0.95)] and institutionalization risk (HR=0.31; 95% CI: 0.09-0.81). The presence of geriatric syndromes did not modify the association of increasing use of guideline recommended medications and clinical outcomes.
  
  
  CONCLUSIONS
  In older men with IHD, greater adherence to medication guidelines appears to be positively associated with better clinical outcomes, independent of geriatric syndromes.
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia. Electronic address: danijela.gnjidic@sydney.edu.au.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia; ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.affiliation: Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Waite
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Handelsman
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimers Institute, Concord RG Hospital, Sydney, NSW, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Discipline of Pharmacology, University of Sydney, Sydney, NSW, Australia.
authors.forename: Slade
authors.initials: S
authors.lastname: Matthews
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics; D006801:Humans; D008297:Male; D055118:Medication Adherence; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality; D019338:Polypharmacy; D013577:Syndrome; D014549:Urinary Incontinence / Q000209:etiology
keywords: All-cause mortality; Geriatric syndromes; Ischemic heart disease; Medication guidelines; Older people