Entete 3

A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy: Findings from the PROPERmed individual participant data meta-analysis.

By Ana I. González (picture on the left), Andreas Meid (picture in the middle), Truc S Dinh, Jeanet W Blom, Marjan van den Akker, Petra JM Elder, Ulrich Thiem, Daniela Küllenberg de Gaudry, Kym Snell, Rafael Perera, Karin MA Swart, Henrik Rudolf, Hans-Joachim Trampish, Joerg J Meerpohl, Benno Flaig, Ghaisom Kom, Walter E Haefeli, Paul P Glasziou, Ferdinand M Gerlach and Christiane Muth (picture on the right*)

Multimorbidity and polypharmacy increase the risk for inappropriate prescriptions and underuse of appropriate medication which may lead to patient deterioration in health-related quality of life (dHRQoL) (1,2). In this heterogeneous general practice population, it would be helpful to identify those patients at high risk of dHRQoL since they may benefit most from complex interventions designed to improve their well-being (3–5).

We aimed to develop and validate a prognostic model to predict dHRQoL at six-month follow-up in older patients with at least one chronic condition and one chronic prescription in general practice (6).

We harmonized individual participant data from five cluster-randomized trials from the Netherlands and Germany. dHRQoL was defined as a decrease in the EQ-5D-3L index score of at least 5% from baseline to 6-month follow-up. Prognostic variables included baseline socio-demographics and lifestyle, morbidity, medication, functional status and well-being related variables. The model was developed using logistic regression with a stratified-intercept to account for between-study heterogeneity in baseline risk. Prognostic variables were selected in complete cases and then refitted in multiply imputed data to obtain the final model equation. Internal validation was performed using bootstrapping within studies to assess reproducibility and internal internal-external cross-validation (IECV) was used to evaluate generalisability.

The complete-case population consisted of 3,582 patients. In 1,046 (29%) patients, health-related quality of life (HRQoL) deteriorated at six-month follow-up. Selected baseline variables contributing significantly to the prediction related to single conditions (i.e. coronary heart disease), prescribed medication (i.e. drugs for acid-related disorders), inappropriate medication (i.e. systemic corticosteroids for maintenance in COPD), medication underuse (e.g. angiotensin converting enzyme inhibitors in heart failure), functional status, and well-being (i.e. HRQoL at baseline and depression), with most prognostic relevance attributable to baseline HRQoL and functional status. Bootstrap internal validation of the final model showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). With the trials as validation datasets in the IECV loop, the final model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (-0.13 to 0.13).

This first IPD-based prognostic model for dHRQoL in older patients with multiple chronic conditions and medication in general practice performed well in discrimination, calibration, and generalisability and might thus help clinicians identify older patients at high risk of dHRQoL.

This work was supported by the German Innovation Funds according to § 92a (2) Volume V of the Social Insurance Code (§ 92a Abs. 2, SGB V – Fünftes Buch Sozialgesetzbuch), grant number: 01VSF16018.The funder had no role in developing the protocol for this review.

The abstract of the article can be accessed at the following link: https://pubmed.ncbi.nlm.nih.gov/33065164/

*Photo: Universität Bielefeld/S. Jonek


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