DIURETIC USAGE AND WITHDRAWAL PATTERNS IN A DUTCH GERIATRIC-PATIENT POPULATION

OBJECTIVES: To describe diuretic usage and withdrawal patterns in a po pulation of very old geriatric patients and to evaluate the long-term probability of remaining free from diuretic therapy after withdrawal. DESIGN: Retrospective analysis of medical records and 1-year follow-up study. SETTING: University Hospital Nijmegen and Rijnstate Hospital A rnhem, a non-academic teaching hospital, The Netherlands. PARTICIPANTS : All 1547 patients, aged 75 years or older, visiting geriatric medici ne departments in the two hospitals for the first time in the years 19 90 through 1993. MEASUREMENTS: Data on medical history, physical exami nations, and medication use were obtained from medical records. Diuret ic withdrawal and motivation was recorded as reported. Record review i ndicating diuretic withdrawal prompted a 1-year follow-up investigatio n and collection of additional updated information from family care an d/or nursing-home physicians. RESULTS: A total of 593 three patients ( 38.3%) were using diuretics. Use of diuretics increased with age from 33.6% in patients aged 75 to 79 years to 47.4% in patients aged 90 yea rs or older (P < .05). Diuretics were withdrawn in 218 patients (36.8% ), in 101 patients because of doubts about the initial or persistent i ndication for diuretic use and in 91 patients because of adverse effec ts. No reasons for withdrawal were reported in 26 patients, Withdrawal of diuretics was attempted more often in cases of diuretic prescripti ons for unknown reasons (51.2%) or ankle edema without heart failure ( 45.0%) than when prescriptions were for heart failure (28.5%) or hyper tension (35.4%). The overall probability of remaining free of diuretic therapy for 1 year das 0.41. Success of diuretic withdrawal ir as sig nificantly less when congestive heart failure was the initial indicati on for prescription (probability 0.24). We did not find other clinical parameters related to the success of withdrawal. CONCLUSIONS: Our stu dy demonstrates that diuretic therapy can be withdrawn for at least a 1-year period in a Substantial number of very old geriatric patients r eceiving these medications, regardless of the initial indications for prescription. However, withdrawal is performed without application of uniform criteria. Future prospective studies should be directed at dev eloping clear guidelines for diuretic withdrawal in order to facilitat e identification of eligible patients and to further improve the succe ss of withdrawal attempts.