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Potentially inappropriate prescribing in Ethiopian geriatric patients hospitalized with cardiovascular disorders
Tadesse Melaku Abegaz1, Eshetie Melese Birru2, Gashaw Binega Mekonnen1
1Department of clinical pharmacy, school of pharmacy, college of medicine and health sciences, university of Gondar, Gondar, Ethiopia.
Insights
Potentially inappropriate prescriptions (PIPs) affected over two-thirds of elderly cardiovascular patients in Ethiopia. Longer hospital stays, comorbidities, and multiple discharge medications increased PIP risk, highlighting the need for medication review.
Area of Science:
- Geriatric Medicine
- Cardiology
- Clinical Pharmacy
Background:
- Limited data exists on potentially inappropriate prescriptions (PIPs) in elderly cardiovascular patients in Ethiopia.
- Cardiovascular disorders are prevalent in the elderly population, increasing medication complexity and risk.
Purpose of the Study:
- To determine the prevalence of PIPs in elderly Ethiopian cardiovascular patients.
- To identify factors associated with PIPs using the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment (STOPP/START) criteria.
Main Methods:
- A hospital-based cross-sectional study was conducted in Ethiopia.
- Medications of 239 elderly patients (≥65 years) with cardiovascular disorders were evaluated using STOPP/START criteria.
- Multivariable logistic regression and ANOVA were used to analyze associated factors and differences in PIPs.
Main Results:
- A high prevalence of PIPs (61.5%) was observed in 147 out of 239 patients.
- Angiotensin Converting Enzyme Inhibitors (ACEIs) were the most frequent inappropriately prescribed medications (14.5%).
- Factors increasing PIP likelihood included longer hospital stay (AOR: 1.086), more discharge medications (AOR: 1.924), and comorbidities (AOR: 3.127).
Conclusions:
- Nearly two-thirds of elderly cardiovascular patients experienced PIPs, with ACEIs being commonly involved.
- Longer hospital stays, comorbidities, and polypharmacy at discharge are significant risk factors for PIPs.
- Implementing STOPP/START criteria during hospitalization is crucial for reducing PIPs in this vulnerable population.
Background:
There was a paucity of data on the magnitude of potentially inappropriate prescriptions (PIPs) among Ethiopian elderly cardiovascular patients.
Objective:
The aim of this study was to assess PIPs and associated factors in the elderly population with cardiovascular disorders using the START/STOPP screening criteria.
Methods:
A hospital-based cross-sectional study was conducted at medical wards of a teaching hospital in Ethiopia from 1 December 2016-30 May 2017. Included patients were hospitalized elderly patients aged 65 years or older with cardiovascular disorders; their medications were evaluated using the START/STOPP screening criteria from admission to discharge. Multivariable logistic regression was applied to identify factors associated with inappropriate medications. One Way Analysis Of Variance (ANOVA) was carried out to test significant differences on the number of PIPs per individual diagnosis.
Results:
Two hundred thirty-nine patients were included in the analysis. More-than a third of the patients were diagnosed with heart failure, 88 (36.82%). A total of 221 PIPs were identified in 147 patients, resulting in PIP prevalence of 61.5% in the elderly population. Of the total number of PIPs, occurrence of one, two and three PIPs accounted for 83 (56.4%), 52(35.4%), and 12(8.2%) respectively. One way ANOVA test showed significant differences on the mean number of PIPs per individual diagnosis (f = 5.718, p<0.001). Angiotensin Converting Enzyme Inhibitors (ACEIs) were the most common inappropriately prescribed medications, 32(14.5%). Hospital stay, AOR: 1.086 (1.016-1.160), number of medications at discharge, AOR: 1.924 (1.217-3.041) and the presence of co-morbidities, AOR: 3.127 (1.706-5.733) increased the likelihood of PIP.
Conclusion:
Approximately, two-thirds of elderly cardiovascular patients encountered potentially inappropriate prescriptions. ACEIs were the most commonly mis-prescribed medications. Longer hospital stay, presence of comorbidities and prescription of large number of medications at discharge have been correlated with the occurrence of inappropriate medication. It is essential to evaluate patients' medications during hospital stay using the STOPP and START tool to reduce PIPs.
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