Evaluation of potentially inappropriate medications in older patients admitted to the cardiac intensive care unit according to the 2019 Beers criteria, STOPP criteria version 2 and Chinese criteria

Abstract

What is Known and Objectives: Potential inappropriate medications (PIMs) can increase the risk of medication-induced harm. However, there are no studies regarding PIMs in older and critically ill patients with cardiovascular diseases in China.Therefore, studies evaluating PIMs in these patients can help in the implementation of more effective interventions to reduce the risk of drug use. Our objective was to analyse the prevalence of PIMs in elderly patients admitted to the cardiac intensive care unit (CICU) comparing the 2019 Beers criteria (Beers criteria), Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP) criteria version 2 (STOPP criteria) and criteria of potentially inappropriate medications for older adults in China (Chinese criteria); and analyse the factors influencing the PIMs. Methods: This cross-sectional and retrospective study was performed with elderly patients (≥65 years) admitted to the CICU of the Beijing Tongren Hospital in China from January 2019 to June 2020. The PIMs were identified based on the Chinese, STOPP and Beers criteria at admission and discharge. The three criteria were compared using the Kappa statistic. Multiple regression analysis was used to investigate the influencing factors associated with PIMs.Results and Discussion: A total of 369 patients who met the inclusion/exclusion criteria were included in this study. According to the three criteria used to evaluate the PIMs, the prevalence was 78.3% and 72.6% at admission and discharge, respectively.The prevalence rate of PIMs determined by the Chinese criteria was 62.1% at admission versus 56.6% at discharge (p = 0.134); the Beers criteria was 53.9% at admission versus 46.9% at discharge (p = 0.056); by the STOPP criteria was 20.6% at admission versus 13.8% at discharge (p = 0.015). Moreover, 28.9% (STOPP criteria), 56.8% (Beers criteria) and 73.4% (Chinese criteria) of patients taking PIMs on admission still had the same problem at discharge. The most common PIMs screened by the Beers, STOPP and Chinese criteria were diuretics, benzodiazepines and clopidogrel, respectively. Besides, the three criteria showed poor agreement. Finally, the stronger predictor of PIMs was the increased number of medications (p < 0.05).

Evaluation of potentially inappropriate medications for the elderly according to beers, STOPP, START, and Chinese criteria

“…In our study, we found that the number of prescribed medications was the strongest independent predictor of PIMs, according to all four criteria. Consistent with our findings, several studies have reported a strong association between polypharmacy and PIM use ( Ma et al, 2018 ; Fernández et al, 2021 ; Tao et al, 2021 ; Bai et al, 2022 ). The median number of medications prescribed to the participants was nine (IQR = 6.25–11), ranging from one to 28.…”

“…The prevalence of PIMs varied widely among studies. Our study is consistent with some previous reports (Zhang et al, 2017;Buda et al, 2020;Bai et al, 2022), but inconsistent with others (Tommelein et al, 2015;Sheikh-Taha and Dimassi, 2017;Fernández et al, 2021). A total of 53.5% patients had at least one PIM identified by the Beers criteria (2015) reported by Zhang X et al at Peking University First Hospital (Zhang et al, 2017).…”

“…Benzodiazepines were the most frequently detected PIMs according to the STOPP criteria, 36 patients (accounting for 13.04%) had PIMs with benzodiazepines accounting for 32.29% of all PIMs. Although the consistency among the three criteria for PIM screening was poor, benzodiazepines were the most common PIMs detected by the Beers, Chinese, and STOPP criteria in our study and others ( Parekh et al, 2019 ; Monteiro et al, 2020 ; Bai et al, 2022 ). In most reports, PPOs are commonly associated with the cardiovascular system.…”

“…A total of 53.5% patients had at least one PIM identified by the Beers criteria (2015) reported by Zhang X et al at Peking University First Hospital ( Zhang et al, 2017 ). A total of 62.1% of patients had PIM use detected by the Chinese criteria, and 53.9% patients had PIM use detected by the 2019 Beers criteria in another study by Bai et al at the Beijing Tongren Hospital ( Bai et al, 2022 ). In the study by Bai et al, a low incidence of 20.6% was also found using the STOPP criteria.…”

“…High prevalence rates of PIM use vary in different healthcare settings, from 20.6% to 87.4% ( Tommelein et al, 2015 ; Sheikh-Taha and Dimassi, 2017 ; Zhang et al, 2017 ; Buda et al, 2020 ; Fernández et al, 2021 ; Bai et al, 2022 ). This study aimed to investigate the prevalence of polypharmacy, PIM use, and the factors associated with PIM use in elderly people aged ≥65 admitted to the Geriatric Department of Shandong Provincial Hospital affiliated to Shandong First Medical University in order to monitor and minimize PIM use.…”