Assessment of Potentially Inappropriate Medications Use and Health Related Quality of Life among Elderly Cardiac Patients: A cross sectional study from Islamabad, Pakistan

Abstract

Introduction According to United Nations (UN) population report, global share of older people will have expected to reach 21% by 2050 and 77% of them will be in developing countries. Age associated pharmacological and physiological changes increased the susceptibly of elderly population to the risks of life-threatening outcomes attributed to potentially inappropriate medications (PIMs). Thus, the aim of current study is to evaluate drug utilization pattern of PIMs, associated factors and association between PIM use and health-related quality of Life among elderly cardiac outpatients. Methodology A cross-sectional prospective survey-based study was conducted at the out-patient department of two tertiary care hospitals from May 2018 to October 2018. Universal random sampling technique was used to approach patients and consented eligible 386 patients were interviewed to collect information about socio-demographics, health, disease-related characteristic and medication history/lab values on a data collection form. Beers Criteria 2015 was used for assessment of potentially inappropriate medications. EQ-5D-3L (Euro QOL) and Barthel index was used to measuring quality of life and performance in activities of daily living respectively. Chi-square tests, Fisher exact test, Mann-Whitney U tests, Kruskal-Wallis test and multivariate binary logistic regression/Linear regression analysis were performed to find factors of PIM by using SPSS version 21. Results Of 386 elderly cardiac patients, 233 (60.3%) patients were receiving polypharmacy (5-9 drugs) and 260 (67.4%) patients were exposed to PIM according to Beers medication list 2015. Most commonly prescribed PIMs were C03AA03 (hydrochlorothiazide, 21.5%), CA03C01 (furosemide, 17.1%), A02BC01 (omeprazole, 13.7%) and N04AB02 (orphenadrine, 6.7%). Logistic regression revealed that factors such as hospital visits, (OR=1.803, P=0.0041), polypharmacy (OR=11.08, P=0.001), excessive polypharmacy (OR=18.831, P=0.005), presence of comorbidity (OR=1.789, P=0.046) and two or more comorbidities (OR=9.42, P=0.008) were significant predictors of PIM use. In Mann-Whitney U test, results showed significant difference in mean EQ-5D scores among patients with PIM (Mean score=0.51) and without PIM (Mean score=0.65) (P<0.001). Linear regression analysis revealed quality of life scores was reduced by 0.043 times among patients with PIM (β= -0.043, P=0.02) and increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores (β= -0.331, P<0.001). Conclusion The present study concluded that PIMs were commonly utilized among geriatric cardiac patients. Exposure to PIM was significantly associated with lower quality of life. This indicates that strict compliance to guidelines recommendations must be followed to improve quality use of medications and patient’s quality of life.