Abstract
Objectives
To evaluate the incidence of deprescribing of antihypertensive medication among older
adults residing in Veterans Affairs (VA) nursing homes for long-term care and rates
of deprescribing after potentially triggering events.
Design
Retrospective cohort study.
Setting and Participants
Long-term care residents aged 65 years and older admitted to a VA nursing home from
2006 to 2019 and using blood pressure medication at admission.
Methods
Data were extracted from the VA electronic health record, and Centers for Medicare
& Medicaid Services Minimum Data Set and Bar Code Medication Administration. Deprescribing
was defined on a rolling basis as a reduction in the number or dose of antihypertensive
medications, sustained for ≥2 weeks. We examined potentially triggering events for
deprescribing, including low blood pressure (<90/60 mmHg), acute renal impairment
(creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium
decrease by 5 mEq/L), and falls.
Results
Among 31,499 VA nursing home residents on antihypertensive medication, 70.4% had ≥1
deprescribing event (median length of stay = 6 months), and 48.7% had a net reduction
in antihypertensive medications over their stay. Deprescribing events were most common
in the first 4 weeks after admission and the last 4 weeks of life. Among potentially
triggering events, a 50% increase in serum creatinine was associated with the greatest
increase in the likelihood of deprescribing over the subsequent 4 weeks: residents
with this event had a 41.7% chance of being deprescribed compared with 11.5% in those
who did not (risk difference = 30.3%, P < .001). A fall in the past 30 days was associated with the smallest magnitude increased
risk of deprescribing (risk difference = 3.8%, P < .001) of the events considered.
Conclusions and Implications
Deprescribing of antihypertensive medications is common among VA nursing home residents,
especially after a potential renal adverse event.
Keywords
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Article info
Publication history
Published online: August 05, 2021
Footnotes
This research was funded by the National Institute on Aging (NIA) (R56AG055576, RF1AG062568). M.A.S.'s effort was supported in part by the NIA (R24AG064025, K24AG049057), S.J.L.’s effort was supported in part by VA HSR&D (IIR 15-434) and NIA (R01AG057751). Z.A.M.’s effort was supported in part by NIA (K76AG059929). C.A.P.'s effort was supported in part by an American Heart Association Established Investigator Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Veteran Health Association.
C.A.P. serves as the Chief Medical Officer for Cricket Health, Inc. M.C.O. serves as a consultant for Cricket Health, Inc. M.A.S. and S.J.L. receive honoraria as authors on UpToDate. The remaining authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
December 15, 2021
December 2021 Issue: Full-Time Nursing Home Practice / Deprescribing / Pain Management / Ventilators
Featuring Dr. Philip Sloane, Dr. Mallory Brown; Recorded: December 8, 2021.
https://mcdn.podbean.com/mf/download/reaa6p/dec2021final.mp3
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