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Call to reduce ‘counter-productive’ cardiovascular drug prescribing in the over-80s

By Lilian Anekwe

Exclusive: Some drugs for the cardiovascular management of elderly patients may be doing more harm than good and needs ‘a fresh look’ in light of real-life experience rather than trial evidence, a senior Government expert has warned.

Dr Keith Ridge, the Department of Health’s chief pharmaceutical officer, said cutting use in the elderly of several commonly used drug classes, including diuretics and warfarin, would save money and drive down hospital admissions.

Dr Ridge told Pulse at an RCGP roundtable discussion on care homes that it was impossible to justify the fact that patients in care homes in their 80s were on an average of eight drugs.

He warned the NHS was failing to get value for money from its prescribing budget, that adverse events were responsible for between 5% and 8% of all hospital admissions. He said antihypertensives in particular often led to falls.

‘We’re at the point where we need to think quite differently about how medicines are used – we need to improve outcomes and extract as much value as possible.

‘We spend £12.5bn a year [on prescribing] but are we getting the best outcomes from medicines? There’s a growing view to suggest we are not. There are probably a limited number of medicines where we can focus our efforts on and get this right, and I think that would lead to a reduction of the use of medicines in care homes.’

Professor Steve Field, who chaired the event in his final week as RCGP chair, said: ‘Often we forget that it’s the complexity of chronic disease that needs managing. Are we doing more harm than good to an 85-year-old or a 90-year-old? The number of antihypertensives we use means they are all on the floor with hypotension. They collapse and break their hip going to the toilet.’

Dr Ridge said it was time for the NHS to move away from the reliance on evidence from clinical trials, and for future policy to be based more on the use of drugs in daily practice.

He said: ‘We spend a lot of time and effort getting drugs to market. But we don’t spend enough time around real clinical effects of medicines in practice. We need to assess how medicines are used in practice as opposed to a clinical trial environment.’

Dr Brian Crichton, a GP in Solihull and a lecturer in therapeutics and pharmacology at the University of Warwick said: ‘We can’t be ageist. We should be looking at patients’ biological rather than chronological age. Just because they have got to 85 we can’t cut them out for treatments.

‘But on the other hand there is evidence that, for example in statins, prescribing to the elderly might be counter-productive. Medicines reviews are occurring in certain parts of the country by pharmacists, and an expansion of that would be welcome.’

Call to reduce ‘counterproductive’ cardiovascular drug prescribing in the over-80s Problems with care home prescribing

DH-commissioned research examined medication prescribing, dispensing, administration and monitoring practices across 55 care homes in three areas of England.
Key findings from DH-commissioned research on care home prescribing:

• Residents with a mean age 85 years were taking an average of 8 medicines

• On any one day 7 out of 10 patients experienced at least one medication error

• Study not designed to detect actual harm but indicated potential for serious harm

• Considerable scope for improvement in how medicines are prescribed, dispensed, administered and monitored in residential care and nursing home settings.

Source: Department of Health letter from Dr Keith Ridge to PCTs and SHAs, 7 January 2010

Interview with Dr Keith Ridge