LOOP DIURETICS IN PATIENTS AGED 75 YEARS OR OLDER - GENERAL-PRACTITIONERS ASSESSMENT OF INDICATIONS AND POSSIBILITIES FOR WITHDRAWAL

Objective: To examine the indications for prescription and possibiliti es for withdrawal of loop diuretics in community-dwelling patients age d 75 years or older, as reported by their general practitioners (GPs). Methods: Analysis of dispensary data to identify patients aged 75 yea rs or older using loop diuretics on 1 February 1996. Questionnaires we re sent to the GPs of these patients to inquire about the indications for loop diuretic prescription and the necessity for continuation. We subsequently determined loop diuretic prescription rates in the survey population over the next 9 months. Setting: A panel of nine Dutch com munity pharmacies. Results: Questionnaires were returned for 338 out o f 667 patients (50.7%) using loop diuretics on 1 February 1996. Report ed indications for loop diuretic use were heart failure in 223 patient s (66.0%), hypertension in 35 patients (10.4%), and a combination of b oth in 23 patients (6.8%). Loop diuretics were used for ankle edema in 27 patients (8.0%) and for unknown reasons in another 27 patients (8. 0%). Continuation of treatment was considered unnecessary by GPs in 66 out of 338 patients (19.5%). However, prescription rates for these 66 patients in the following months were no different from rates for the remaining 272 patients. Loop diuretics were still prescribed to 47 of 66 patients (71.2%) after 12 weeks: and to 26 patients (39.4%) after 36 weeks. Conclusions: GPs reported substantial opportunities for with drawal of loop diuretics in patients over 75 rears of age, but this di d not influence actual prescription rates in these patients. Future st udies should explore means of facilitating withdrawal of these medicat ions in this population.