Use of Preventive Medication in Patients With Limited Life Expectancy: A Systematic Review

Optimal prescribing in patients with limited life expectancy (LLE) remains unclear. This study systematically reviews the published literature regarding the use of preventive medication in patients with reduced life expectancy. A systematic literature search was conducted using three databases (MEDL...

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Vydáno v:Journal of pain and symptom management Ročník 53; číslo 6; s. 1097 - 1110.e1
Hlavní autoři: Poudel, Arjun, Yates, Patsy, Rowett, Debra, Nissen, Lisa M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.06.2017
Elsevier Limited
Témata:
ACE inhibitors
Anesthesia & Perioperative Care
Calcium channel blockers
Cancer
Cardiovascular diseases
Cognitive impairment
Criteria
Dementia
Drug Prescriptions
Drugs
End of life decisions
Evidence-based medicine
Hospitalization
Humans
Illnesses
Inappropriate Prescribing
Life Expectancy
Limited life expectancy
Literary criticism
Literature reviews
Medical Overuse
Nursing Homes
Observational studies
optimal prescribing
Optimization
Osteoporosis
Pain Medicine
Palliative Care
Patients
Polypharmacy
Prescribing
Preventive Health Services - methods
preventive medication
Statins
symptomatic treatment
Systematic review
Terminal Care
symptomatic treatment
Limited life expectancy
optimal prescribing
preventive medication
ISSN:0885-3924, 1873-6513, 1873-6513
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Shrnutí:Optimal prescribing in patients with limited life expectancy (LLE) remains unclear. This study systematically reviews the published literature regarding the use of preventive medication in patients with reduced life expectancy. A systematic literature search was conducted using three databases (MEDLINE, EMBASE, and CINAHL). Articles published in English from January 1995 to December 2015 were retrieved for analysis to identify peer-reviewed, observational studies assessing use of preventive medications in patients with LLE. Inclusion criteria were: patients with a LLE (less than or equal to two years); prescribed/used preventive medications. Of the 15 studies meeting our eligibility criteria, six were from inpatient hospital settings, five in palliative care, three in nursing homes, and one in community settings. The most common life-limiting illnesses described in the studies were cancer (n = 6), cardiovascular diseases (n = 4), dementia and cognitive impairment (n = 2), and other life-limiting illnesses (n = 3). Lipid-lowering medications, especially the statins were frequently prescribed preventive medication followed by antiplatelets, angiotensin converting enzyme inhibitors and angiotensin receptor blockers, anti-osteoporosis medications, and calcium channel blockers. Only four studies reported the instances of medication withdrawal. Patients continue to receive medications that are not prescribed as symptomatic treatment despite having a LLE. Very few rigorous studies have been conducted on minimizing preventive medications in patients with LLE, and expert opinion varies on medication optimization at the end of life. A consensus guideline that addresses this gap is of paramount importance.
Bibliografie:ObjectType-Article-2
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ObjectType-Evidence Based Healthcare-1
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ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2016.12.350