Straand J, Fugelli P, Laake K. Withdrawing long-term diuretic treatment among elderly patients in general practice. Family Practice 1993;10:38-42.
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/8477891
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 33 enrolled, 33 completed
Age: 82 years (range 75 to 95 years) Sex: 25 female, 8 male Participants with dementia: No Inclusion criteria · 75 years of age and older · lived at home · Seen at the medical practice on two or more occasions · Last visit not more than 2 years previously Exclusion criteria: · Diuretic dosage increased during the last 6 months · Homebound or for other reasons not able to participate in the study · Systolic BP >220 mmHg · Diastolic BP > 110 mmHg · Heart failure, functional classes (New York Hear Association) III and IV Country: Norway Setting: Community – two health center clinics |
| Interventions | Medicine: Diuretic (about one-third used a thiazide, one-third took furosemide, and one-third were on a potassium-sparing diuretic).
The mean duration of the diuretic treatment was 10 years. The reason for the diuretic use was: · Hypertension (n=12) · Heart failure (n=6) · Peripheral edema (n=5) · No identifiable reason (n=10) Withdrawal schedule: Not described |
| Outcomes | Successful deprescribing |
| Dates | Dates: Not described
Follow-up duration: Six months |
| Funding sources | The Norwegian Medicinal Depot and The Norwegian National Health Association (Nasjonalforeningen for Folkehelsen) |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | A descriptive study design. |
| Allocation concealment (selection bias) | High risk | No concurrent control group. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Open study. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | Open study. |
| Incomplete outcome data (attrition bias) | 1 out of 5 | No missing data. |
| Selective reporting (reporting bias) | 4 out of 5 | The researchers do not appear to have had a pre-specified protocol and analysis plan. There is no available published protocol, but the outcomes are straightforward.
Criteria used were the Criteria for re-establishment of diuretic therapy. The criteria themselves were not reported, but the interpretation was. Separately, events leading to re-establishment were reported. |
| Confounding (non-randomized) | 5 out of 5 | No list of confounders, no control group and no account taken of other medication. |
| Other bias | Low risk | |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of the average older adults in the community taking diuretics. |
| Selection of the non-exposed cohort | No concurrent control cohort. | |
| Ascertainment of exposure | Ascertainment of exposure was by secure record.
|
|
| Demonstration that outcome of interest was not present at start of study | Demonstrated that outcome of interest was not present at start of study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controlled for diuretic cessation. |
| Outcome bias | Assessment of outcome | Assessment of outcome: record linkage. |
| Was follow-up long enough for outcomes to occur | Follow-up was long enough for outcomes to occur. | |
| Adequacy of follow-up of cohorts | Complete follow-up – all subjects accounted for | |
Leave a Reply