Abstract Body

Background and purpose

With accumulation of diseases, limitations and approaching end of life, the question rises for whom cardiovascular preventive medication (CPM) is still appropriate. We aimed to assess how various clinical characteristics influence the appropriateness of cholesterol lowering treatment, blood pressure lowering treatment and platelet aggregation inhibitors in older adults.

Methods

With the RAND/ UCLA appropriateness Method (RAM) the appropriateness of CPM for adults ≥75 year was assessed, depending on cardiovascular history, complexity of health problems, age, side-effects and life expectancy. The RAM consists of a preparation phase and two rounds of individual ratings by panelists, with one face-to-face panel between these rounds. A treatment was considered appropriate when the expected benefits exceed the negative consequences by a sufficiently wide margin. The multidisciplinary panel consisted of eleven (medical) experts with diverse backgrounds and three older people.

Results

The panelists emphasized the importance of the individual context when deciding to start or stop CPM. However, different patterns of appropriateness judgments across the clinical scenarios and types of medication were found. In general, absence of cardiovascular disease, presence of complex health problems, a life-expectancy < 1 year, and hindering side-effects were important factors in decreasing the appropriateness of medication. Stopping CPM was judged differently than not starting.

Conclusions

In the final decision to start or stop CPM, the individual context was considered decisive. However, general trends of how clinical characteristics influence the appropriateness according to the panelists were identified. Also, stopping and not starting CPM appeared to be two distinct concepts.