Journal of cardiology · 2025
Trends and factors associated with potentially inappropriate medication use in older adults hospitalized for heart failure: A nationwide analysis using the JROAD-DPC database.
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Nakao Kazuhiro, Nishimura Kunihiro, Shishido Toshiaki, Nakao Yoko M, Sumita Yoko, Kanaoka Koshiro, Nakai Michikazu, Nochioka Kotaro, Miyamoto Yoshihiro, Noguchi Teruo, Yasuda Satoshi
Аннотация
BACKGROUND: Avoiding potentially inappropriate medications (PIMs) that can worsen heart failure (HF) is a clinical priority. Yet, the prevalence and determinants of PIM use in this population are not well characterized. The Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC) database is a nationwide claims-based registry that captures detailed information on hospitalizations for cardiovascular disease across Japan, providing a unique opportunity to examine prescribing patterns in real-world practice.
METHODS: We analyzed JROAD-DPC data on hospitalizations for HF among patients aged ≥ 60 years between 2012 and 2020, in a study supported by the Japan Agency for Medical Research and Development. The temporal trend in the utilization of HF-exacerbating PIMs listed in the American Geriatrics Society Beers Criteria®, non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, non-dihydropyridine calcium-channel blockers (CCBs), cilostazol, and thiazolidinediones, was assessed using Cochran-Armitage trend tests. Factors associated with PIM use were evaluated using multivariate mixed-effects Poisson regression models, with hospitals treated as random intercepts.
RESULTS: A total of 1,232,368 HF hospitalizations were analyzed. The overall prevalence of PIM use declined over time: NSAIDs and COX-2 inhibitors decreased from 15.7 % in 2012 to 9.2 % in 2020, and non-dihydropyridine CCBs from 14.5 % to 9.7 %. Despite this decline, these medications continued to be prescribed for a substantial proportion of patients. Utilization patterns differed by patient characteristics; notably, women were more likely than men to receive NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs.
CONCLUSIONS: Although the use of HF-exacerbating PIMs has decreased over time, NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs remain commonly prescribed. Given their potential to worsen HF outcomes, raising clinical awareness of PIMs and addressing patient-specific prescribing patterns are essential steps toward safer pharmacological management in older adults with HF. Findings from JROAD-DPC highlight the ongoing need for strategies to further minimize PIM-related risks.
METHODS: We analyzed JROAD-DPC data on hospitalizations for HF among patients aged ≥ 60 years between 2012 and 2020, in a study supported by the Japan Agency for Medical Research and Development. The temporal trend in the utilization of HF-exacerbating PIMs listed in the American Geriatrics Society Beers Criteria®, non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, non-dihydropyridine calcium-channel blockers (CCBs), cilostazol, and thiazolidinediones, was assessed using Cochran-Armitage trend tests. Factors associated with PIM use were evaluated using multivariate mixed-effects Poisson regression models, with hospitals treated as random intercepts.
RESULTS: A total of 1,232,368 HF hospitalizations were analyzed. The overall prevalence of PIM use declined over time: NSAIDs and COX-2 inhibitors decreased from 15.7 % in 2012 to 9.2 % in 2020, and non-dihydropyridine CCBs from 14.5 % to 9.7 %. Despite this decline, these medications continued to be prescribed for a substantial proportion of patients. Utilization patterns differed by patient characteristics; notably, women were more likely than men to receive NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs.
CONCLUSIONS: Although the use of HF-exacerbating PIMs has decreased over time, NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs remain commonly prescribed. Given their potential to worsen HF outcomes, raising clinical awareness of PIMs and addressing patient-specific prescribing patterns are essential steps toward safer pharmacological management in older adults with HF. Findings from JROAD-DPC highlight the ongoing need for strategies to further minimize PIM-related risks.