Evidence map›Paper›PMID 37495948›Full record

ArticleBMC cardiovascular disorders2023

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure.

Esther Liu, Musarrat Nahid, Mahad Musse, Ligong Chen, Sarah N Hilmer, Andrew Zullo, Min Ji Kwak, Mark Lachs, Emily B Levitan, Monika M Safford and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC cardiovascular disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.9field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 2 countries.

Esther LiuDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
Musarrat NahidDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
Mahad MusseDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
Ligong ChenUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Sarah N HilmerThe University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia.
Andrew ZulloBrown University School of Public Health, Providence, USA.
Min Ji KwakThe University of Texas, Houston, TX, USA.
Mark LachsDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
Emily B LevitanUniversity of Alabama at Birmingham, Birmingham, AL, USA.
Monika M SaffordDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
Parag GoyalDepartment of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA. pag9051@med.cornell.edu.
Cornell University · USUniversity of Alabama at Birmingham · USBrown University · USRoyal North Shore Hospital · AUUniversity of Houston · US

Funding

VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
REGARDS - MI StudyR01HL080477 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI LEVITAN, EMILY B, SAFFORD, MONIKA M · 2006 to 2020
$11.6M
U.S. Deprescribing Research NetworkR24AG064025 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI BOYD, CYNTHIA MELINDA, STEINMAN, MICHAEL A. · 2019 to 2023
$9.9M
A Novel Deprescribing Intervention for Heart Failure with Preserved Ejection Fraction (HFpEF): A Prototype for Older Adults with Multimorbidity and PolypharmacyK76AG064428 · NIA · WEILL MEDICAL COLL OF CORNELL UNIV · PI GOYAL, PARAG · 2020 to 2024
$1.1M
Impact of Polypharmacy on Rehospitalization in Older Adults with Heart FailureR03AG056446 · NIA · WEILL MEDICAL COLL OF CORNELL UNIV · PI GOYAL, PARAG · 2017 to 2018
$265k
NHLBI NIH HHS R01 HL080477NIA NIH HHS K76 AG064428NIA NIH HHS R03 AG056446NIA NIH HHS R24 AG064025NINDS NIH HHS U01 NS041588
6 · The paper itself

Abstract

backgroundOlder adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden.

methodsWe used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003-2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003-2017. We determined FRIDs -cardiovascular (CV) and non-cardiovascular (non-CV) medications - at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors.

resultsAmong 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14).

conclusionsFRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.

Indexed as

Accidental FallsHeart FailureAgedFemaleHospitalizationHumansMalePatient DischargeProspective StudiesFall risk-increasing drugsFallsHeart failure

Identifiers

PMID37495948
PMCPMC10373421
OpenAlexW4385285977

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.