Evaluation of Fall-related Injuries Following a Potential Calcium Channel Blocker — Loop Diuretic Prescribing Cascade

Friday, August 26, 2022

1:45 PM – 2:00 PM CEST

Location: C1M0

Publication Number: 50

Background: The calcium channel blocker (CCB)-edema-loop diuretic prescribing cascade has been consistently described using multiple data sources. The subsequent risk of downstream consequences due to unnecessary use of loop diuretics, especially in older adults, has yet to be explored.

Objectives: To evaluate the risk for fall-related injuries following a potential CCB-edema-loop diuretic prescribing cascade in older adults as a measure of downstream consequences.

Methods: We created a cohort of CCB initiators aged ≥66 years old without a diagnosis of heart failure and identified first use of a loop diuretic within 180 days (potential prescribing cascade) between 2011 and 2018 using Medicare Fee-For-Service data. Patients who did not initiate a loop diuretic within 180 days served as control patients with their cohort entry date frequency matched to resemble the distribution of time between CCB and loop diuretic initiation. Patients were followed until diagnosis of a fall-related injury or censoring event (heart failure diagnosis, death, end of study period; whichever occurred first). A multivariable Cox proportional hazards regression model was used to compare the risk of fall-related injuries between patients with and without the potential prescribing cascade after adjusting for age, sex, race, diagnosis of Alzheimer's disease, frailty, and Charlson Comorbidity Index.

Results: We identified 125,514 CCB initiators, of which 4,647 (3.7%) initiated loop diuretics within 180 days. The incidence of fall-related injuries was 23.81 (95% CI 22.16-25.58) per 100 patient-years compared to 17.06 (95% CI 16.79-17.32) per 100 patient-years among the non-users, resulting in an incidence rate ratio of 1.40 (95% CI 1.30-1.50). The HR of fall-related injuries was 1.17 (95% CI 1.09-1.26) in patients initiating loop diuretics compared with non-users.

Conclusions: Our findings suggested a slight increase in fall-related injuries following a potential CCB-edema-loop diuretic prescribing cascade compared to non-loop diuretic users.

Presenting Author(s)

Scott M. Vouri, PharmD, PharmD, PhD, PhD

Assistant Professor
University of Florida College of Pharmacy
Gainesville, Florida, United States

Slides

Co-Author(s)

GW

Grace (Hsin Min) Wang

University of Florida Department of Pharmaceutical Outcomes and Policy
Gainesville, Florida, United States
Earl J. Morris, IV, PharmD, MPH

University of Florida - Department of Pharmaceutical Outcomes & Policy
Gainesville, Florida, United States
LS

Laurence Solberg

VA North Florida/South Georgia Health Care System, United States
MD

Michael Daniels

University of Florida, United States
CP

Carl Pepine

University of Florida College of Medicine, United States
TM

Todd Manini

University of Florida College of Medicine, United States
DM

Daniel Malone, RPh, PhD, FAMCP

Professor
University of Utah College of Pharmacy
Salt Lake City, UT, United States
Almut Winterstein, PhD, FISPE

Distinguished Professor
University of Florida
Gainesville, Florida, United States