Abstract
BackgroundPolypharmacy is often considered suggestive of suboptimal prescribing, and is associated with adverse outcomes. It is particularly common in the context of cardiovascular disease, but it is unclear whether prescribing of multiple cardiovascular medicines, which may be entirely appropriate and consistent with clinical guidance, is associated with adverse outcome. The aim of this study was to assess the relationship between number of prescribed cardiovascular medicines and unplanned non-cardiovascular hospital admissions.MethodsA retrospective cohort analysis of 180,815 adult patients was conducted using Scottish primary care data linked to hospital discharge data. Patients were followed up for one year for the outcome of unplanned non-cardiovascular hospital admission. The association between number of prescribed cardiovascular medicines and hospitalisation was modelled using logistic regression, adjusting for key confounding factors including cardiovascular and non-cardiovascular morbidity and non-cardiovascular prescribing.Results25.4% patients were prescribed ≥1 cardiovascular medicine, and 5.7% were prescribed ≥5. At least one unplanned non-cardiovascular admission was experienced by 4.2% of patients. Admissions were more common in patients receiving multiple cardiovascular medicines (6.4% of patients prescribed 5 or 6 cardiovascular medicines) compared with those prescribed none (3.5%). However, after adjusting for key confounders, cardiovascular prescribing was associated with fewer non-cardiovascular admissions (OR 0.66 for 5 or 6 vs. no cardiovascular medicines, 95% CI 0.57-0.75).ConclusionsWe found no evidence that increasing numbers of cardiovascular medicines were associated with an increased risk of unplanned non-cardiovascular hospitalisation, following adjustment for confounding. Assumptions that polypharmacy is hazardous and represents poor care should be moderated in the context of cardiovascular disease.
Highlights
Polypharmacy is often considered suggestive of suboptimal prescribing, and is associated with adverse outcomes
Cardiovascular disease (CVD) is one area where polypharmacy may be of particular relevance
Despite the clear burden of cardiovascular disease and the volume of medications used in its management it remains unclear, whether prescribing of multiple cardiovascular medicines, which may well be entirely appropriate and in keeping with current evidence and guidance, is necessarily still associated with adverse outcomes
Summary
Polypharmacy is often considered suggestive of suboptimal prescribing, and is associated with adverse outcomes. It is common in the context of cardiovascular disease, but it is unclear whether prescribing of multiple cardiovascular medicines, which may be entirely appropriate and consistent with clinical guidance, is associated with adverse outcome. Despite the clear burden of cardiovascular disease and the volume of medications used in its management it remains unclear, whether prescribing of multiple cardiovascular medicines, which may well be entirely appropriate and in keeping with current evidence and guidance, is necessarily still associated with adverse outcomes. We decided to examine the potential impact of polypharmacy on unplanned hospital admissions, as a general measure of quality of care. It was decided to examine non-cardiovascular admissions, as we did not believe it would be possible to tease out any adverse or beneficial effects of cardiovascular medication from underlying cardiovascular disease severity
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