968-P: Cardiovascular Risk Management in the Elderly: A Nationwide Register Study of Discontinuation Patterns Prior to Death

Abstract

In the elderly population with type 2 diabetes (T2D), decisions about discontinuation of medication is important, as it may lead to improved outcomes and reduced polypharmacy-associated adverse events. However, the extent, patterns and secular changes of discontinuation of cardioprotective medication during the last years of life have been scarcely described. All individuals with T2D that died at age ≥ 80, between 2006-2018 were identified through the Danish Diabetes Register and linked to the Register of Medicinal Products Statistics. The population was followed backward in time, from death to date of last intake of cardioprotective medication. To estimate the cumulative proportion on different medication classes, we fitted a crude Poisson regression model for the rate of medication with time before death. A total of 52,523 persons (55% female) were identified, with a mean (SD) age at T2D diagnosis of 77 (8) years, a median (Q1-Q3) age at death of 86 (83-90) years and a median (Q1-Q3) diabetes duration at death of 9 (5-14) years. From year of death in 2006 to 2018, we found an increased utilization of antihypertensive and lipid-lowering medication, during the last 10 years of life, while the opposite was true for aspirin (ASA) (Figure 1). We also found a simultaneous increase in discontinuation rates during the last years of life, which was particularly pronounced during the last year of life. Disclosure V. Kosjerina: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk. M. E. Jorgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. B. Brock: None. H. Christensen: None. J. Rungby: None. G. S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S.