Potentially inappropriate use of furosemide in a very elderly population: An observational study
Résumé
Objective
Little is known about furosemide prescription modalities in elderly people. We describe furosemide prescription in ambulatory elderly patients.
Methods
All patients aged over 80 years, affiliated to Mutualité Sociale Agricole de Bourgogne, a French regional health insurance plan, with a medical prescription delivered in March 2015, were retrospectively included.
Results
Among 15 141 patients with a median age of 86 years, comprising 61.3% of women, 3937 patients (26%) had a prescription for furosemide. Severe heart failure was the most common chronic comorbidity (27.7%). Furosemide was considered a long-term therapy for almost all patients (98.7% with prescriptions for 3 months or more). Recommended indications for long-term furosemide therapy included severe heart failure (50.9%), chronic nephropathy (3%) and cirrhosis (0.1%). The furosemide prescription rate increased with age (81-85: 20.4%, 86-90: 28.5%, 91-95: 35.6%, >95: 42.7%, P<.001), and the increase was associated with a decrease in recommended heart failure therapeutics (beta-blockers, angiotensin-conversion-enzyme-inhibitors or angiotensin-receptor-blockers). Prescribers were mostly general practitioners (81.3%). Plasma electrolytes were controlled in less than a half of the patients with furosemide.
Conclusions
In this large study, long-course furosemide was prescribed in a quarter of ambulatory patients. Half of those taking furosemide suffered from severe heart failure. Age was associated with a linear increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. A large part of these prescriptions do not seem to be in accordance with recommendations.
What's known
Loop diuretics are the only effective drugs for the treatment of fluid retention and are mainly indicated in congestive heart failure. However, their chronic use is associated with iatrogenic effects and increased long-term mortality, especially in elderly people.
What's new
Long-course furosemide prescription concerned as much as a quarter of this large cohort of ambulatory patients aged over 80 years, of whom half suffer from severe chronic heart failure. Age was associated with a major increase in furosemide use and a decrease in recommended heart failure therapeutic prescriptions. This may reflect the palliative pharmacologic care of older patients, limited to symptom reduction.