ArticlePloS one2015
Medication Underuse in Aging Outpatients with Cardiovascular Disease: Prevalence, Determinants, and Outcomes in a Prospective Cohort Study.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- The relationship between frailty and polypharmacy in older people: A systematic review.British journal of clinical pharmacology · 2018Pooled it
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- Missed opportunities for risk reduction: type 1 diabetes management in older adults in DPV and T1DX-QI registries.Journal of the Endocrine Society · 2026Article
- Medication Use by Older Adults with Frailty: A Scoping Review.Pharmacy (Basel, Switzerland) · 2025Review
- Association between frailty and inappropriate prescribing in elderly patients admitted to an Acute Care of the Elderly Unit.Aging medicine (Milton (N.S.W)) · 2024Article
- Article
- Pharmacotherapy for Coronary Artery Disease and Acute Coronary Syndrome in the Aging Population.Current atherosclerosis reports · 2024Review
- Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon.Health science reports · 2022Article
- Article
- Article
- Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database.The Annals of pharmacotherapy · 2020Article
- Differences in Cardiovascular Care Between Adults With and Without Opioid Prescriptions in the United States.Journal of the American Heart Association · 2020Article
- Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy.Journal of the American Geriatrics Society · 2019Article
- Article
- Pharmacotherapy in Older Adults with Cardiovascular Disease: Report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging Workshop.Journal of the American Geriatrics Society · 2019Article
- Relationship between frailty, polypharmacy, and underprescription in older adults living in nursing homes.European journal of clinical pharmacology · 2018Article
- Real-world complexity of atrial fibrillation treatment with oral anticoagulants: design and interpretation of pharmacoepidemiological studies.British journal of clinical pharmacology · 2017Article
- Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old.British journal of clinical pharmacology · 2016Article
- Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study.British journal of clinical pharmacology · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiovascular disease is a leading cause of death in older people, and the impact of being exposed or not exposed to preventive cardiovascular medicines is accordingly high. Underutilization of beneficial drugs is common, but prevalence estimates differ across settings, knowledge on predictors is limited, and clinical consequences are rarely investigated.
methodsUsing data from a prospective population-based cohort study, we assessed the prevalence, determinants, and outcomes of medication underuse based on cardiovascular criteria from Screening Tool To Alert to Right Treatment (START).
resultsMedication underuse was present in 69.1% of 1454 included participants (mean age 71.1 ± 6.1 years) and was significantly associated with frailty (odds ratio: 2.11 [95% confidence interval: 1.24-3.63]), body mass index (1.03 [1.01-1.07] per kg/m2), and inversely with the number of prescribed drugs (0.84 [0.79-0.88] per drug). Using this information for adjustment in a follow-up evaluation (mean follow-up time 2.24 years) on cardiovascular and competing outcomes, we found no association of medication underuse with cardiovascular events (fatal and non-fatal) (hazard ratio: 1.00 [0.65-1.56]), but observed a significant association of medication underuse with competing deaths from non-cardiovascular causes (2.52 [1.01-6.30]).
conclusionMedication underuse was associated with frailty and adverse non-cardiovascular clinical outcomes. This may suggest that cardiovascular drugs were withheld because of serious co-morbidity or that concurrent illness can preclude benefit from cardiovascular prevention. In the latter case, adapted prescribing criteria should be developed and evaluated in those patients.
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