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Potentially inappropriate medication use in elderly patients with heart failure: beers criteria-based review
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1Lebanese University - Beirut - Lebanon
2American University of Beirut Medical Center - Beirut - Lebanon
Background: Elderly heart failure (HF) patients are considered among the highest consumers of drugs. Their complex drug regimens and various comorbidities predispose them to inappropriate prescribing of medications. "Beers criteria" is among the most widely used criteria for the evaluation of potentially inappropriate medications (PIMs) use in elderly patients. Purposes: The aim of this study is to evaluate the proportion of PIMs in elderly HF patients as well as the factors associated with the number of PIMs. Also, to test for the correlation between PIMs and the impairment in quality of life and depression in this vulnerable population. Methods: This study is using an observational cross-sectional design, targeting 120 consecutive HF outpatients =65 years, with ejection fraction <50%, who are being recruited from a tertiary care center. Patients with history of acute coronary event in the preceding 3 months and patients with severe cognitive impairments are excluded. Data for medications, doses, clinical data, and demographics are collected at discharge from the clinic. Patient is interviewed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for measuring quality of life and the patient health questionnaire (PHQ9) for depression. Data are then evaluated for the use of PIMs using the updated Beer’s criteria 2015. Results: In total, 74.8% of our sample are males, 58.9% are young-old patients (65-74 years), and 68.2% had a history of hypertension. The total number of medications taken by our sample is 924 with an average of 8.64±2.82 medication per prescription. Preliminary results showed that the percentage of patients receiving at least one PIM is 80.4%, with an average of 1.70 ± 1.26 PIM per prescription, and 29.0% of HF patients are having 2 PIM in their prescription. Most of the PIMs are from the category of medications to use with caution (63.6%) and to be avoided in many or most older adults (53.3%). Diuretics (57.0%), proton pump inhibitors (41.1%), aspirin (14.0%), and benzodiazepines (9.3%) are the most commonly prescribed PIMs. Significant correlation is found between number of PIMs per patient with the MLHFQ score (pearson's coefficient r= 0.28, p=0.003), PHQ9 score (r=0.23, p=0.017), and number of medications per prescription (r=0.49, p<0.001). Multivariate Linear regression showed a significant association between the number of PIMs per prescription with the number of medications (regression coefficient beta=0.190, p<0.001), oldest-old age (beta=1.136, p=0.006), and having a chronic kidney disease (beta=0.588, p=0.031). Conclusions: Elderly HF patients are having a high percentage of PIMs. An excessive unnecessary use of proton pump inhibitors is observed in this population. The PIMs are affecting negatively the quality of life of HF patients and associated with more depression. There is a need for a multidisciplinary team to help in controlling the prescription of PIMs in this vulnerable population.
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