Evaluation of medication appropriateness index in cardiovascular outpatient clinic: A cross-sectional study

Older adults often have polypharmacy and multimorbidity. Cardiovascular diseases (CVDs) are the most common multimorbidities in older adults and are linked to wide range of adverse drug effects and drug-related problems. The medication appropriateness index (MAI) has been widely used in several patient settings to assess Potentially Inappropriate Medication (PIM) prescribing in older adults.

The purpose of this study was to evaluate PIM prescribing in cardiovascular disease outpatient clinic. It also aimed at assessing the validity of the MAI to detect and quantify PIMs specifically in CVD outpatient clinics.

This was a cross-sectional, single-center study in cardiovascular outpatient setting. Demographic, clinical, and medication information from older adults (≥ 65 years old) were collected and reviewed. Two clinical pharmacists randomly selected 70 patients, evaluated 539 medications, and assessed their appropriateness using the MAI. The Statistical Package for the Social Sciences (SPSS) descriptive and logistic regression analyses was to calculate the number of PIMs, the MAI scores, and factors associated with PIM prescribing.

Our data showed that 87.1 % of patients had at least one PIM and the number of PIMs per patient was 2.10. Approximately 60 % of the patients had an MAI weighted score of zero (no prescription error). The mean MAI score per patient was 17.61 and the mean MAI score per medication was 2.72. The overall agreement between the two raters was 87.3 % with moderate chance-adjusted agreement as indicated by the kappa static of 0.43. The factors that were associated with increased PIM prescribing were the total number of medications and being ≥85 years old.

A relatively high prevalence of PIMs was found in the studied population. The MAI is a reliable and valid tool to detect PIM prescribing in CVD outpatient clinics. It mandates implementing specific measures to reduce PIMs.