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[Validity of cardiovascular prescriptions to the guidelines in the elderly according to the STOPP and START method]

Marie Coupet1, Delphine Renvoize, Camille Rousseau

  • 1Service de médecine gériatrique, Hôpital Decker, Centre hospitalier Bretagne Atlantique, Vannes, France.

Geriatrie Et Psychologie Neuropsychiatrie Du Vieillissement
|September 13, 2013
PubMed

Insights

Medical prescriptions for elderly patients with cardiovascular diseases often don't align with guidelines. Key issues include under-prescribing ACE inhibitors for heart failure and atrial fibrillation anticoagulation, highlighting areas for improved geriatric care.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Pharmacology

Context:

  • Cardiovascular diseases are a leading cause of mortality in the elderly.
  • Assessing prescription appropriateness against clinical guidelines is crucial for this demographic.
  • Geriatric units hospitalize a significant number of elderly patients with complex health needs.

Purpose:

  • To evaluate the adherence of cardiovascular medication prescriptions to established guidelines in elderly patients.
  • To identify specific areas of non-compliance, including inappropriate prescriptions and under-prescribing.

Summary:

  • A retrospective analysis of 736 geriatric patients (mean age 86.7) revealed prescription discrepancies.
  • Inappropriate prescriptions included calcium channel blockers with constipation (9%) and high-dose aspirin (>150mg/day) (8.4%).
  • Under-prescribing was noted for ACE inhibitors in heart failure (19%) and post-myocardial infarction (15.8%), and anticoagulation for atrial fibrillation (11%).

Impact:

  • Identified significant gaps between clinical practice and guidelines for heart failure and atrial fibrillation management in the elderly.
  • Highlights the need for improved prescribing, particularly considering factors like advanced age, dependency, and renal insufficiency.
  • Suggests opportunities for optimizing cardiovascular care in geriatric populations to reduce mortality and morbidity.

Keywords:
STOPP-STARTcardiovascular diseasesdrug prescriptionselderly

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