Deprescribing heart medications may backfire

The benefit from describing medicines in the elderly has been put in doubt with a South Australian study showing that withdrawal of cardiovascular medications is associated with worse mortality.

The prospective study followed 239 medical inpatients ≥75 years on five or more medications prior to admission who were discharged to permanent residential aged care.

It found patients who had medications deprescribed had a nonsignificantly greater odds of dying within 90 days (OR 3.23; p = 0.136).

However deprescribing antihypertensives (OR 2.27, p = 0.05), statins (OR 4.95; p = 0.005) and diuretics (OR 0.33; p= 0.05) was significantly associated with increased mortality at 90 days. Readmissions and 1-year mortality rates were similar and there was no deterioration in quality of life when medications were deprescribed.

The study found patients with the least medication changes had the lowest mortality. The authors said deprescribing medications for inpatients in the last phase of life remained an important, but moving target.

“Nonspecific deprescribing might be no more beneficial than nonspecific prescribing,” they concluded.

Read more in Therapeutic Advances in Drug Safety

AV block alert for octreotide

A TGA Medicines Safety Update has flagged reports from Europe of atrioventricular blocks in patients receiving high doses of continuous intravenous infusion of octreotide and in patients receiving bolus octreotide intravenously.

The severity of atrioventricular block varies, with complete heart block resulting in cardiac arrest. Patients receiving high doses may need cardiac monitoring and treatment may include pacemaker insertion.

While the approved indications for octreotide in Australia do not involve intravenous administration, the TGA is aware there may be off-label use.

“With this in mind, the TGA is advising health professionals of the identified risk of atrioventricular blocks in patients receiving off-label high doses of continuous infusion (100 micrograms/hour) of octreotide and in patients receiving bolus octreotide intravenously (50 micrograms bolus followed by 50 micrograms/hour continuous infusion),” the Safety Update said.

Conservative media users adopt antivax beliefs

People who rely on conservative media outlets are more likely to accept conspiracy theories about the COVID-19 pandemic and less likely to accept pandemic mitigation measures such as mask-wearing and vaccination, a US study has found.

A national survey of 883 people running from March to November 2020 found that users of conservative media such as Fox News initially supported vaccination and trusted the Center for Disease Control (CDC) advice at the outset of the study, but continued exposure to conservative media reduced support for both.

People who were exposed to conservative media displayed increasing belief in pandemic conspiracies which were associated with reduced support for pandemic prevention measures.

In contrast, users of mainstream media sources showed enhanced trust in preventive behaviour and in public health authorities across the pandemic, and did not exhibit change in pandemic conspiracy beliefs over time, but heavy users of conservative media remain largely impervious to these influences.

“The selective use of these media enhances belief in conspiracies that pose challenges to the country’s ability to control a public health crisis such as the COVID pandemic,” the study authors concluded.

Read more in Social Science and Medicine