Potentially inappropriate home medications among older patients with cardiovascular disease admitted to a cardiology service in USA

Sheikh-Taha, Marwan; Dimassi, Hani

doi:10.1186/s12872-017-0623-1

Cited by 42 publications

(47 citation statements)

References 23 publications

(11 reference statements)

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“…However, 41.6% of the patients were receiving PPIs without a clear indication for it, and this unnecessary use of PPIs is widespread among different countries and not restricted only to HF patients. [ 9,22,23 ] Therefore, the inappropriate consumption of PPIs should be controlled by a proper evaluation of the patients’ medical and medication history.…”

Section: Discussionmentioning

confidence: 99%

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Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Zahwe

Skouri

Rachidi

et al. 2020

International Journal of Pharmacy Practice

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Objectives Primary objectives were to evaluate the use of potentially inappropriate medication (PIM) use in elderly heart failure (HF) patients and the factors associated with the number of PIMs. Secondary objectives were to test for the correlation between PIMs and quality of life (QOL) and depression. Methods A cross‐sectional study was conducted among 125 elderly Lebanese HF patients with left ventricular ejection fraction <50%. Data on socio‐demographics, clinical data and medications were collected. Patients were interviewed with Minnesota living with Heart Failure Questionnaire (MLHFQ) and Patient Health Questionnaire‐9 (PHQ‐9). Medication profile per patient was evaluated for PIMs using Beers Criteria. The correlations between the number of PIMs and the MLHFQ, PHQ‐9 and the number of medications were tested using Pearson’s correlation. Linear regression was done to predict the factors associated with the number of PIMs. Key findings Patients were taking a total of 1035 medications with a mean of 8.28 ± 3.14 medications. In total, 80.0% of patients were taking at least one PIM. Diuretics (55.2%) and proton pump inhibitors (41.6%) were most commonly prescribed PIMs. The number of PIMs was moderately correlated with the number of medications and the MLHFQ score. Linear regression showed that the number of medications, age ≥85 years, chronic kidney disease and HF with New York Heart Association III were associated with more PIMs. Conclusions A high percentage of PIMs was found among a sample of elderly Lebanese HF patients. HF multidisciplinary team is needed to control the prescription of PIMs in this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

“…This high consumption of benzodiazepine is common between older persons as highlighted by other studies. [ 11,22,23 ] Although there are several alternatives that have been shown to be efficacious in elderly, [ 24 ] patient‐specific assessment is needed to choose the most effective alternative having the lowest risk to the patient.…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Zahwe

Skouri

Rachidi

et al. 2020

International Journal of Pharmacy Practice

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“…Another commonly prescribed PIM in our study was taken by participants who were diagnosed with the gastroesophageal reflux disease (GERD). A recent study examining the PIM use among older patients with cardiovascular disease also listed the unnecessary use of PPIs common among older adults [ 44 ]. It is important that providers carefully consider the use of PPIs in older adults and monitor their continued use to prevent the drug-drug interactions and side effects, including risk of Clostridium difficile infection, bone loss, and fractures [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medication use among hypertensive older African-American adults

2018

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BackgroundInappropriate use of medications, particularly among minority older adults with co-morbidity, remains a major public health concern. The American Geriatrics Society (AGS) reports that Potentially Inappropriate Medication (PIM) continues to be prescribed for older adults, despite evidence of poor outcomes. The main objective of this study was to examine the prevalence of PIM use among underserved non-institutionalized hypertensive older African-American adults. Furthermore, this study examines potential correlations between PIM use and the number and type of chronic conditions.MethodsThis cross-sectional study is comprised of a convenience sample of 193 hypertensive non-institutionalized African-American adults, aged 65 years and older recruited from several senior housing units located in underserved areas of South Los Angeles. The updated 2015 AGS Beers Criteria was used to identify participants using PIMs.ResultsAlmost one out of two participants had inappropriate medication use. While the average number of PIMs taken was 0.87 drugs, the range was from one to seven medications. Almost 23% of PIMs were due to drugs with potential drug-drug interactions. The most common PIM was the use of proton pump inhibitors (PPI) and Central Nervous System (CNS) active agents. Nearly 56% of PIMs potentially increased the risk of falls and fall-associated bone fractures. The use of PIMs was significantly higher among participants who reported a higher number of chronic conditions. Nearly 70% of participants with PIM use reported suffering from chronic pain.ConclusionsThe major reason for high levels of polypharmacy, PIMs, and drug interactions is that patients suffer from multiple chronic conditions. But it may not be possible or necessary to treat all chronic conditions. Therefore, the goals of care should be explicitly reviewed with the patient in order to determine which of the many chronic conditions has the greatest impact on the life goals and/or functional priorities of the patient. Those drugs that have a limited impact on the patient’s functional priorities and that may cause harmful drug-drug interactions can be reduced or eliminated, while the remaining medications can focus on the most important functional priorities of the patient.

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“…Another study conducted in Karachi, Pakistan had revealed that at least 1 PIM was prescribed to more than half (64%) of the older population [ 46 ]. It is suggested that many of the PIMs like antihistaminic agents (e.g., diphenhydramine), proton pump inhibitors (e.g., omeprazole and esomeprazole) and analgesics (e.g., aspirin and non-steroidal anti-inflammatory drugs (NSAIDS)) are more frequently used by older people than any other age group [ 47 , 48 , 49 ]. This might be attributable to the reason that old age people mostly suffer from insomnia, heart burn, acid reflex, headache, muscle pain, and joint pain due to multiple co-morbidities and the physicians in developing countries like Pakistan are usually inefficient in diagnosing the underlying cause [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

2018

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Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

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Potentially inappropriate home medications among older patients with cardiovascular disease admitted to a cardiology service in USA

Cited by 42 publications

References 23 publications

Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Potentially inappropriate medications in elderly patients with heart failure: Beers Criteria-based study

Potentially inappropriate medication use among hypertensive older African-American adults

Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

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