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

Abstract

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

Acknowledgments

The authors would like to acknowledge the LTCFs and the community pharmacy for all the work in data extraction and for their participation in this study. The authors would also like to thank Fundação para a Ciência e a Tec-nologia, I.P. (FCT), Ministério da Ciência e da Tecnologia, Portugal for the PhD Grant to João Pedro Aguiar (SFRH/ BD/132785/2017).

Disclosure

The authors report no conflicts of interest in this work.

Supplementary material

Table S1 Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly