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The health impacts of preventive cardiovascular medication reduction on older populations: protocol for a systematic review and meta-analysis.
Syst Rev. 2021 06 24; 10(1):185.SR

Abstract

BACKGROUND

Polypharmacy is inevitable and appropriate for many conditions, but in some cases, it can be problematic resulting in an increased risk of harm and reduced quality of life. There has been an increasing interest to reduce cardioprotective medications in older adults to potentially reduce the risk of harm due to treatment; however, there is no evidence on safety and efficacy to support this practice currently. This paper describes a protocol for a systematic review on the safety and efficacy of reducing cardioprotective medication in older populations.

METHODS

MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Central Register of Controlled Trials) will be searched from their inception onwards for relevant studies. Randomised controlled trials and non-randomised studies on interventions (prospective, retrospective cohort, case-control) conducted in older adults (75 years or older) examining reduction of cardioprotective medications will be included. The primary outcome of this study will be all-cause hospitalisation. Secondary outcome variables of interest are all-cause hospitalisation, mortality, quality of life, serious adverse events, major adverse cardiovascular events, falls, fractures, cognitive functioning, bleeding events, renal functioning, medication burden, drug reinstatement, time-in-hospital, and frailty status. Two reviewers will independently screen all citations, full-text articles, and extract data. Confidence in cumulative evidence will be assessed using the GRADE approach; the risk of bias will be assessed by the RoB-II tool for randomised controlled studies and ROBINS-I for non-randomised studies. Where sufficient data are available, we will conduct a random effects meta-analysis by combining the outcomes of the included studies. Sub-group analysis and meta-regression are planned to assess the potential harms and risks of different drug classes and the impacts in different patient populations (e.g. sex, cognitive status, renal status, and age).

DISCUSSION

The study will be a comprehensive review on all published articles identified using our search strategy on the safety and efficacy of cardioprotective medication reduction in the older population. The findings will be crucial to inform clinicians on potential health outcomes of reducing cardiovascular medication in the elderly.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020208223.

Links

Authors+Show Affiliations

van der Veen RS

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK. rik.vanderveen@phc.ox.ac.uk.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

MeSH

AgedFrailtyHumansMeta-Analysis as TopicPolypharmacyProspective StudiesQuality of LifeRetrospective StudiesReview Literature as Topic

Pub Type(s)

Journal Article

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34167593

Citation

van der Veen, Rik S., et al. "The Health Impacts of Preventive Cardiovascular Medication Reduction On Older Populations: Protocol for a Systematic Review and Meta-analysis." Systematic Reviews, vol. 10, no. 1, 2021, p. 185.

van der Veen RS, Lee JJ, McManus RJ, et al. The health impacts of preventive cardiovascular medication reduction on older populations: protocol for a systematic review and meta-analysis. Syst Rev. 2021;10(1):185.

van der Veen, R. S., Lee, J. J., McManus, R. J., Hobbs, R. F. D., Mahtani, K. R., Koshiaris, C., & Sheppard, J. P. (2021). The health impacts of preventive cardiovascular medication reduction on older populations: protocol for a systematic review and meta-analysis. Systematic Reviews, 10(1), 185. https://doi.org/10.1186/s13643-021-01741-2

van der Veen RS, et al. The Health Impacts of Preventive Cardiovascular Medication Reduction On Older Populations: Protocol for a Systematic Review and Meta-analysis. Syst Rev. 2021 06 24;10(1):185. PubMed PMID: 34167593.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - The health impacts of preventive cardiovascular medication reduction on older populations: protocol for a systematic review and meta-analysis. AU - van der Veen,Rik S, AU - Lee,Joseph J, AU - McManus,Richard J, AU - Hobbs,Richard F D, AU - Mahtani,Kamal R, AU - Koshiaris,Constantinos, AU - Sheppard,James P, Y1 - 2021/06/24/ PY - 2020/11/19/received PY - 2021/06/09/accepted PY - 2021/6/25/entrez PY - 2021/6/26/pubmed PY - 2021/7/6/medline KW - Adverse events KW - Aged KW - Cardiovascular therapy KW - Deprescribing KW - Inappropriate prescribing KW - Medication reduction KW - Multimorbidity KW - Problematic polypharmacy KW - Quality of life SP - 185 EP - 185 JF - Systematic reviews JO - Syst Rev VL - 10 IS - 1 N2 - BACKGROUND: Polypharmacy is inevitable and appropriate for many conditions, but in some cases, it can be problematic resulting in an increased risk of harm and reduced quality of life. There has been an increasing interest to reduce cardioprotective medications in older adults to potentially reduce the risk of harm due to treatment; however, there is no evidence on safety and efficacy to support this practice currently. This paper describes a protocol for a systematic review on the safety and efficacy of reducing cardioprotective medication in older populations. METHODS: MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Central Register of Controlled Trials) will be searched from their inception onwards for relevant studies. Randomised controlled trials and non-randomised studies on interventions (prospective, retrospective cohort, case-control) conducted in older adults (75 years or older) examining reduction of cardioprotective medications will be included. The primary outcome of this study will be all-cause hospitalisation. Secondary outcome variables of interest are all-cause hospitalisation, mortality, quality of life, serious adverse events, major adverse cardiovascular events, falls, fractures, cognitive functioning, bleeding events, renal functioning, medication burden, drug reinstatement, time-in-hospital, and frailty status. Two reviewers will independently screen all citations, full-text articles, and extract data. Confidence in cumulative evidence will be assessed using the GRADE approach; the risk of bias will be assessed by the RoB-II tool for randomised controlled studies and ROBINS-I for non-randomised studies. Where sufficient data are available, we will conduct a random effects meta-analysis by combining the outcomes of the included studies. Sub-group analysis and meta-regression are planned to assess the potential harms and risks of different drug classes and the impacts in different patient populations (e.g. sex, cognitive status, renal status, and age). DISCUSSION: The study will be a comprehensive review on all published articles identified using our search strategy on the safety and efficacy of cardioprotective medication reduction in the older population. The findings will be crucial to inform clinicians on potential health outcomes of reducing cardiovascular medication in the elderly. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020208223. SN - 2046-4053 UR - https://www.unboundmedicine.com/medline/citation/34167593/The_health_impacts_of_preventive_cardiovascular_medication_reduction_on_older_populations:_protocol_for_a_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -