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

João Pedro Aguiar,1 Luís Heitor Costa,2 Filipa Alves da Costa,3,4 Hubert GM Leufkens,5 Ana Paula Martins1 1Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; 2Serviço de Medicina Interna, Cent...

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Autores principales:	Aguiar JP, Heitor Costa L, Alves da Costa F, Leufkens HGM, Martins AP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Elderly Inappropriate Prescribing Cardiovascular Risk NSAIDs Antipsychotics Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/c4df599aea194df1a04c1b67a3d0f712
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spelling	oai:doaj.org-article:c4df599aea194df1a04c1b67a3d0f7122021-12-02T00:49:08ZIdentification of potentially inappropriate medications with risk of major adverse cardiac and cerebrovascular events among elderly patients in ambulatory setting and long-term care facilities1178-1998https://doaj.org/article/c4df599aea194df1a04c1b67a3d0f7122019-03-01T00:00:00Zhttps://www.dovepress.com/identification-of-potentially-inappropriate-medications-with-risk-of-m-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998João Pedro Aguiar,1 Luís Heitor Costa,2 Filipa Alves da Costa,3,4 Hubert GM Leufkens,5 Ana Paula Martins1 1Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; 2Serviço de Medicina Interna, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal; 3Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal; 4Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; 5Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands Purpose: Cardiovascular diseases (CVDs) are extremely common among the elderly, but information on the use of potentially inappropriate medications (PIMs) with cardiovascular risk is scarce. We aimed to determine the prevalence of PIMs with risk of cardiac and cerebrovascular adverse events (CCVAEs), including major adverse cardiac and cerebrovascular events (MACCE). Patients and methods: A cross-sectional study was performed using a convenience sample from four long-term care facilities and one community pharmacy in Portugal. Patients were included if they were aged 65 or older and presented at least one type of medication in their medical and pharmacotherapeutic records from 2015 until December 2017. The main outcome was defined as the presence of PIMs with risk of MACCE and was assessed by applying a PIM-MACCE list that was developed from a previous study. All medications included in this list were assessed for their availability in Portugal. Results: A total of 680 patients were included. Of those, 428 (63%) were female with a mean age of 78.4±8.1 years. Four-hundred and four (59.4%) patients were taking medications associated with CCVAEs risk (mean =1.7±1.0 drugs/patient), including 264 patients (38.8%) who used drugs with MACCE risk (mean =1.4±0.8 drugs/patient). Fifty percent of patients with a previous history of CVD (n=521) were taking PIMs with risk of CCVAEs, including 30.0% with risk of MACCE. Conclusion: Our findings show that 50% of patients with previous history of CVD were taking drugs with risk of CCAVEs and 30% with risk of MACCE. More tailored tools for the management of drug therapy in elderly patients with CVD are of major importance in clinical practice. Keywords: patient safety, therapeutic uses, outcome process assessment (health care), cardiovascular risk, NSAIDs, antipsychoticsAguiar JPHeitor Costa LAlves da Costa FLeufkens HGMMartins APDove Medical PressarticleElderlyInappropriate PrescribingCardiovascular RiskNSAIDsAntipsychoticsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 535-547 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Elderly Inappropriate Prescribing Cardiovascular Risk NSAIDs Antipsychotics Geriatrics RC952-954.6
spellingShingle	Elderly Inappropriate Prescribing Cardiovascular Risk NSAIDs Antipsychotics Geriatrics RC952-954.6 Aguiar JP Heitor Costa L Alves da Costa F Leufkens HGM Martins AP 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
description	João Pedro Aguiar,1 Luís Heitor Costa,2 Filipa Alves da Costa,3,4 Hubert GM Leufkens,5 Ana Paula Martins1 1Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; 2Serviço de Medicina Interna, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal; 3Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal; 4Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; 5Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands Purpose: Cardiovascular diseases (CVDs) are extremely common among the elderly, but information on the use of potentially inappropriate medications (PIMs) with cardiovascular risk is scarce. We aimed to determine the prevalence of PIMs with risk of cardiac and cerebrovascular adverse events (CCVAEs), including major adverse cardiac and cerebrovascular events (MACCE). Patients and methods: A cross-sectional study was performed using a convenience sample from four long-term care facilities and one community pharmacy in Portugal. Patients were included if they were aged 65 or older and presented at least one type of medication in their medical and pharmacotherapeutic records from 2015 until December 2017. The main outcome was defined as the presence of PIMs with risk of MACCE and was assessed by applying a PIM-MACCE list that was developed from a previous study. All medications included in this list were assessed for their availability in Portugal. Results: A total of 680 patients were included. Of those, 428 (63%) were female with a mean age of 78.4±8.1 years. Four-hundred and four (59.4%) patients were taking medications associated with CCVAEs risk (mean =1.7±1.0 drugs/patient), including 264 patients (38.8%) who used drugs with MACCE risk (mean =1.4±0.8 drugs/patient). Fifty percent of patients with a previous history of CVD (n=521) were taking PIMs with risk of CCVAEs, including 30.0% with risk of MACCE. Conclusion: Our findings show that 50% of patients with previous history of CVD were taking drugs with risk of CCAVEs and 30% with risk of MACCE. More tailored tools for the management of drug therapy in elderly patients with CVD are of major importance in clinical practice. Keywords: patient safety, therapeutic uses, outcome process assessment (health care), cardiovascular risk, NSAIDs, antipsychotics
format	article
author	Aguiar JP Heitor Costa L Alves da Costa F Leufkens HGM Martins AP
author_facet	Aguiar JP Heitor Costa L Alves da Costa F Leufkens HGM Martins AP
author_sort	Aguiar JP
title	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
title_short	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
title_full	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
title_fullStr	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
title_full_unstemmed	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
title_sort	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
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/c4df599aea194df1a04c1b67a3d0f712
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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

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