Assessment of Inappropriate Prescription via Using STOPP/START Criteria and Quality of Life in Elderly Cardiac In-patients in Tertiary Care Hospital Mardan (MTI)

Abstract

Background: Within medical field drug utilization research is a recognized area which is a useful tool in accessing variation in prescribing practices and rationalization of medication therapy. It also contribute towards accessing drug utilization and its impact on the community. For health decision makers, drug utilization research has a great value in making drug guidelines and health related policies. The use of drug in any medical condition should be weight against its benefits. Potentially inappropriate prescribing covers, medications use in a condition, in which the adverse drug events outweighs the clinical benefit. The medication regime of such population is very complex and it increases the chances of drug-drug and drug-disease interactions. Such errors in the management of medications, effect badly the patient health, increases hospitalization and mortality. Potentially inappropriate prescribing also increases the chances of adverse drug reactions (ADRs), which in turn enhances the emergency department visits and decreases good health outcomes. START and STOPP are explicate screening tool for the assessment of appropriateness of medication in patient aged about sixty five or above (>65 years). In geriatric pharmacology, 18 experts validated these tools through Delphi consciences process. The aim of this study was to assess the potentially inappropriate prescribing (PIPs) prevalence amongst the elderly cardiac patients of Pakistan using STOPP/START updated criteria. Methodology: A single center prospective Cross-sectional study was conducted at Mardan Medical complex, of about 351 in-patients having Cardiovascular disease and aged> 65 years. Results: A total of three hundarad and fifty one patients were admitted to the medical ward during the stud period. Most of the patient are in 65-74 years age groupe and lessesr in the age group i-e above 85 years. Past medical hostory of about 63 patients with hypertension, CAD plus HTN were 26 and 50 with no history. Ten medications were prescribed for 54 aptients and 12 for 24 and 25 medications for two patients. 118 patients have no anxiety and depression, 186 have mild and 47 have severe anxiety and depression. Total PIMs were reported 154 (44.72%) Loop diuretic as firstline treatment for hypertension 50 (14.2) was the most PIM, 30 duplicate medications were prescribed and the use of Spironolactone with K-sparing medications without checking the level of K+ frequency were 29. Total PPOs were reported as 154(43.87%). ACEIs with systolic heart failure/coronary artery disease that is 46 (13.1) was omitted, Beta-blocker with ischemic heart disease and Statin therapy with coronary, cerebral or peripheral vascular disease were mostly omitted. There is signifancant differences in most of the characteristics that is number of medications (P=0.021), hospital stay days (<0.001), gender (0.006) and socioeconomic status have p-value 0.002. Patient quality of life and PIPs has association in mobility (p=0.02) and usual activities (p=0.043). there life quality domains are asspciatted with PIPs which means it effect QoL. Conclusion: The study concluded that the practice of PIPs in elderly cardiac patients was commonly utilized. The common PIM were the use of loop diuretics, duplication of medications, spironolactone with potassium sparing drugs and the most common PPOs were ACEIs, betablockers and statins. Higher prevalence rate of PIPs was because of following local and internationa guidelines. It was aslo concluded that patients characteristics affect the occurance of PIPs. Age, socioeconomic staus, hospital stay days and medication number rae the characteristics that effect PIPs occurance. Key words: Potentially inappropriate medications prescribings, potential prescription omission, START/STOPP