Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing

Abstract

Summary What is known and objective In the last decades, many lists have been developed to screen for inappropriate prescribing. However, information on which potentially inappropriate medications (PIMs) could increase the cardiovascular risk in the elderly is not objectively presented. This review aimed to identify and quantify those PIMs by extracting information from published PIM‐lists. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Statement (PRISMA), a systematic review of PIM‐lists was conducted. The search strategy was run in PubMed, MEDLINE and Google Scholar (1991‐09/2017). All PIMs described in those lists were extracted and stratified by their potential cardiovascular risk (including major adverse cardiovascular events—MACE). The number of times each PIM was reported on those lists was also assessed. Results and discussion We identified 724 papers, and 24 were retained. From those, a total of 17 PIMs to be avoided by the elderly and 21 drug‐disease interactions were retrieved. The reporting of PIMs with risk of cardiovascular adverse events was 15.3%, whereas the reporting of those with MACE risk was 7.2%. PIMs most frequently described were tricyclic antidepressants (TCAs; 12/24), centrally acting antiadrenergic agents (11/24), NSAIDs (7/24), antiarrhythmics (Class I and III; 6/24), peripherally acting antiadrenergic agents (6/24) and antithrombotic agents (5/24). Most frequently described PIMs with MACE risk were NSAIDs (7/24), antiarrhythmics (Class I and III) (7/24), selective calcium channel blockers with vascular effects (6/24) and antipsychotics (4/24). What is new and conclusion Data suggest that PIM‐lists focus mainly on common adverse events and often poorly describe the potential consequence for MACE occurrence. This systematic review could help healthcare professionals in the identification and deprescribing of these medicines in older patients with high cardiovascular risk during medication review.

<p>Identification of potentially inappropriate medications with risk of major adverse cardiac and cerebrovascular events among elderly patients in ambulatory setting and long-term care facilities</p>

“…Some of these medications can increase the risk of cardiovascular events or even exacerbate underlying conditions. Our previous systematic review showed that there is a restricted number of PIMs described addressing their association with the risk of cardiovascular adverse events 20. Some pharmacotherapeutic groups have been established to be associated with cardiovascular events such as nonsteroidal anti-inflammatory drugs (NSAIDs), antipsychotics, selective calcium channel blockers, and dopaminergic agents.…”

Operacionalização para Portugal da Lista EU(7)-PIM para Identificação de Medicamentos Potencialmente Inapropriados nos Idosos

“…20 Com o objetivo de reduzir o uso de PIM nesta população têm sido desenvolvidos critérios de classificação que permitem avaliar a sua prevalência e desenvolver estratégicas para reduzir a sua utilização. 20,21 Os critérios criados podem ser classificados como explícitos, implícitos ou mistos. 21 Os explícitos constituem listas de medicamentos que podem ser aplicados com a mínima informação e julgamento clínico, não abordando as diferenças individuais entre os doentes, enquanto que os critérios implícitos consideram o regime terapêutico do doente e são baseados no julgamento de um profissional de saúde, sendo específicos para o doente.…”

“…20,21 Os critérios criados podem ser classificados como explícitos, implícitos ou mistos. 21 Os explícitos constituem listas de medicamentos que podem ser aplicados com a mínima informação e julgamento clínico, não abordando as diferenças individuais entre os doentes, enquanto que os critérios implícitos consideram o regime terapêutico do doente e são baseados no julgamento de um profissional de saúde, sendo específicos para o doente. 21 Apesar de não existirem critérios nacionais, Soares et al publicaram em 2008 a operacionalização dos critérios de Beers para Portugal.…”

“…21 Os explícitos constituem listas de medicamentos que podem ser aplicados com a mínima informação e julgamento clínico, não abordando as diferenças individuais entre os doentes, enquanto que os critérios implícitos consideram o regime terapêutico do doente e são baseados no julgamento de um profissional de saúde, sendo específicos para o doente. 21 Apesar de não existirem critérios nacionais, Soares et al publicaram em 2008 a operacionalização dos critérios de Beers para Portugal. 22 Os critérios de Beers são uma ferramenta de critérios explícitos desenvolvida pela Sociedade Americana de Geriatria, e têm vindo a sofrer diversas alterações ao longo dos anos, sendo a última atualização de 2019.…”

Polypharmacy Among Older Brazilians: Prevalence, Factors Associated and Sociodemographic Disparities (ELSI-Brazil)

“…Moreover, polypharmacy has been found to be associated with a variety of negative outcomes in older adults, such as falls, mental impairment, cognitive decline, increase of hospital length-of-stay and readmission [11][12][13]. Another important problem is the lack of therapy adherence, given that complex therapeutic regimes are di cult to manage properly [14,15].…”