Evaluation of potentially inappropriate medication in older patients with cardiovascular diseases—STOPP/START-based study

Abstract

ObjectiveThis study aims to evaluate the use of STOPP/START criteria in the identification of Potentially inappropriate medication and potential prescribing omissions in older patients with cardiovascular diseases in Bulgaria. Excessive morbidity and mortality has been linked to drug-related problems and increased use of healthcare services and is an understudied problem for Bulgaria.Materials and methodsA prospective, questionnaire-based study was conducted among 543 older patients across 25 pharmacies in Bulgaria. Socio-demographic characteristic, disease profile, symptoms, and medication data were collected. The questionnaire was developed for the purposes of the EUROAGEISM project. Out of all 543 patients, only those with documented cardio-vascular diseases were extracted and the medication profile per patient was evaluated for Potentially inappropriate medication (PIMs) and potentially prescribing omissions (PPOs) using STOPP/START criteria version 2. In addition, several risks for potentially inappropriate prescribing (PIPs), PPOs and PIMs were calculated with the focus being on the Odds and Risks to develop a PIP.ResultsFour hundred and twenty eight from 531 patients with known therapy for cardiovascular diseases (CVDs) were included in the analysis of PIP (40.52% aged 65–69 years, 61.88% female, 64% had up to 6 comorbidities, and 21.72% presenting with polypharmacy). A total of 71 PIMs in 64 patients with polypharmacy were identified during applying STOPP criteria. 56% of patients taking above five medicines daily had PIMs. The majority of PIMs (31%) were related to CVDs treatment, followed by PIMs in the treatment of endocrine diseases (22.54%), duplication of medicines (8.46%) and prolonged treatment with benzodiazepines (8.46%). Forty four PPOs were identified with START criteria. 22.72% were related to lack of proton pump inhibitors (PPI) in the presence of gastroesophageal disorders, and the same percentage was for lack of Calcium-vitamin D supplementation in osteoporosis. Applying the methodology of risks calculation the sample risk for PPO was 2.1% and for PIM 3.4%. At sample level the relative risk for PPO was 62% out of the risk for PIM and at population level varied between 42.8 and 89.8% and it is statistically significant. The number needed to treat for the event to happen is 77.5, meaning that at every 78 prescriptions there is a chance to appear PIP.ConclusionApplication of methodologies for detection of potentially inappropriate prescribing is not part of routine clinical practice in Bulgaria. Our study demonstrates a high percentage of potentially inappropriate medication among older patients with polypharmacy. Along with the aging population in Bulgaria, economic burden of polypharmacy and the prevalence of cardiovascular diseases, it is especially important to address potentially inappropriate medication use in cardiovascular patients. There is a considerable necessity for implementation of measures for early detection of potentially inappropriate medication and potentially prescribing omission as a part of de-prescribing strategies in older patients.

Gender Differences in Potentially Inappropriate Medication Use among Older Adults

“…In the current investigation, after controlling for several patient-level characteristics, the most important common predictors for PIM use among older men and women were diabetes, ischemic heart disease, anxiety, and polypharmacy. Comorbidities have been cited as contributing factors to using PIM in several published studies [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. In addition to specific medical conditions, the present study identified a significant association between polypharmacy and higher rates of PIM use.…”

Potentially Inappropriate Medications Use among Older Adults with Dyslipidaemia

“…This finding aligns with a prospective cross-sectional study that included 428 patients receiving established treatment for cardiovascular diseases (CVDs). The vast majority of PIMs (31%) were used to treat CVDs, followed by 22.54% used to treat endocrine disorders [ 24 ].…”

“…There are no studies that have examined PIM usage in older persons with dyslipidemia, despite research among older adults showing a high prevalence of PIM use [ 10 ]. The majority of research [ 13 , 14 , 22 , 23 , 24 , 25 ] involved older persons with cardiovascular illnesses and did not focus specifically on older adults with a cardiovascular risk factor such as dyslipidemia. Recently published articles have emphasized the link between PIM use and cardiovascular diseases [ 13 , 14 , 22 , 23 , 24 , 25 ].…”

“…The majority of research [ 13 , 14 , 22 , 23 , 24 , 25 ] involved older persons with cardiovascular illnesses and did not focus specifically on older adults with a cardiovascular risk factor such as dyslipidemia. Recently published articles have emphasized the link between PIM use and cardiovascular diseases [ 13 , 14 , 22 , 23 , 24 , 25 ]. An analysis of 404 patients’ retrospective charts who had a history of cardiovascular illness and were admitted to the cardiology program revealed that 20% of all drugs recorded were PIMs [ 23 ].…”

“…There are no studies that have examined the use of PIMs in older persons with dyslipidemia. Most research focused on older persons with cardiovascular disorders in general rather than older adults with dyslipidemia [ 13 , 14 , 22 , 23 , 24 , 25 ]. Locally, previous research revealed alarming PIMs usage (60%) in older persons with dyslipidemia from ambulatory-care patients [ 10 ] but no study particularly looked at PIMs usage-related characteristics in this population.…”