Non-recommended Drugs Research Articles

Child COVID-19 vaccine uptake among participants of the 2015 Pelotas (Brazil) Birth Cohort Study

ObjectiveTo analyze COVID-19 vaccine uptake in children and to investigate factors associated with two outcomes variables: (a) not even beginning; (b) not completing the COVID-19 vaccine series. MethodsWe used data of children aged 6–7 years from the 2015 Pelotas c Birth Cohort Study. COVID-19 vaccination status was collected from immunization cards and National Immunization Program Information System. Adjusted analyses were performed using a hierarchical model to identify factors associated with the two study outcomes. ResultsAmong 3867 children, 20.7 % (95 % CI, 19.5 %–22.0 %) did not even begin the 2-dose primary COVID-19 vaccine series, and 28.2 % (95 % CI, 26.6 %–29.8 %) did not complete the series with the second dose. Children not even beginning the COVID-19 vaccine series were more likely to have a White mother, not to have obesity, to have a history of COVID-19 infection, to have received non-recommended drugs for COVID-19, to be afraid of needles, and to have an incomplete diphtheria-tetanus-pertussis (DTP) and poliovirus immunization schedule. Not completing the 2-dose series was associated with lower maternal age and education, mother’s self-identification as White or Brown, lower household income, lack of access to health services, not having completed the DTP and poliovirus immunization schedule and living with a person with a history of infection with COVID-19. ConclusionThe results highlight a vaccine-hesitant parents’ group who chose not beginning the COVID-19 vaccine series of their children and, another group of parents who failure to complete the child’s series due to difficulty accessing health services.

The Impact of Prescribing Monitoring Policy on Drug Use and Expenditures in China: A Multi-center Interrupted Time Series Study.

A prescribing monitoring policy (PMP) was implemented in November 2015 in Anhui province, China, the first province to pilot this policy to manage the use and costs of select drugs based on their large prescription volumes and/ or costs in hospitals. This study evaluated the impact of PMP on the use and expenditures of different drugs in three tertiary hospitals in Anhui. We obtained monthly drug use and expenditures data from three tertiary hospitals in Anhui (November 2014 through September 2017). An interrupted time series (ITS) design was used to estimate changes in defined daily doses (DDDs per month) and drug expenditures (dollars per month) of policy-targeted and non-targeted drugs after PMP implementation. Drugs were grouped based on whether they were recommended (recommended drugs) by any clinical guidelines or not (non-recommended drugs), or if they were potentially over-used (proton pump inhibitors, PPIs). After PMP, DDDs and costs of the targeted PPIs (omeprazole) declined while use of non-targeted PPIs increased correspondingly with overall sustained declines in total PPIs. The policy impact on recommended drugs varied based on whether the targeted drugs have appropriate alternatives. The DDDs and costs of recommended drugs that have readily accessible appropriate alternatives (atorvastatin) declined, which offset increases in its alternative non-target drugs (rosuvastatin), while there was no significant change in those recommended drugs that did not have appropriate alternative drugs (clopidogrel and ticagrelor). Finally, the DDDs and costs of non-recommended drugs decreased significantly. PMP policy impact was not the same across different drug groups. PMP did help contain the use and costs of potentially over-used drugs and non-recommended drugs. PMP did not seem to reduce the use of first-line therapeutic drugs recommended by clinical treatment guidelines, especially those lacking alternatives; such drugs are unlikely appropriate candidates for PMP.

Correction to: Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study

HomeJournal of the American Heart AssociationVol. 12, No. 10Correction to: Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study Open AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessCorrectionPDF/EPUBCorrection to: Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study Originally published15 May 2023https://doi.org/10.1161/JAHA.122.027688Journal of the American Heart Association. 2023;12:e027688This article corrects the followingUse of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort StudyOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 15, 2023: Ahead of Print In the article by Camilla H. B. Jespersen et al, “Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study,” which published online March 21, 2023 (J Am Heart Assoc. 2023;12:e028424. DOI: 10.1161/JAHA.122.028424) and was included in the April 4, 2023 issue of the journal, a correction was needed.The name of the 16th author, Jacob Tfelt‐Hansen, was incorrectly written in the published article as Jacob Tfelt Hansen. This error has now been corrected.The authors regret the error.The online version of the article has been updated and is available here: https://www.ahajournals.org/doi/10.1161/JAHA.122.028424. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesUse of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort StudyCamilla H. B. Jespersen, et al. Journal of the American Heart Association. 2023;12 May 16, 2023Vol 12, Issue 10 Article InformationMetrics Copyright © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.https://doi.org/10.1161/JAHA.122.027688PMID: 37183878 Originally publishedMay 15, 2023 PDF download

Artículo traducido] Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo

ObjectiveTo assess the pharmacist’s contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. ResultsWe reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons.Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases).Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). ConclusionsThe integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.

Use of Nonrecommended Drugs in Patients With Brugada Syndrome: A Danish Nationwide Cohort Study.

Background Patients with Brugada syndrome (BrS) are recommended to avoid drugs that may increase their risk of arrhythmic events. We examined treatment with such drugs in patients with BrS after their diagnosis. Methods and Results All Danish patients diagnosed with BrS (2006-2018) with >12 months of follow-up were identified from nationwide registries. Nonrecommended BrS drugs were grouped into drugs to "avoid" or "preferably avoid" according to http://www.brugadadrugs.org. Cox proportional hazards analyses were performed to identify factors associated with any nonrecommended BrS drug use, and logistic regression analyses were performed to examine associated risk of appropriate implantable cardioverter defibrillator therapy, mortality, and a combined end point indicating an arrhythmic event of delayed implantable cardioverter defibrillator implantation, appropriate implantable cardioverter defibrillator therapy, and mortality. During a median follow-up of 6.8 years, 93/270 (34.4%) patients with BrS (70.4% male, median age at diagnosis 46.1 years [interquartile range, 32.6-57.4]) were treated with ≥1 nonrecommended BrS drugs. No difference in any nonrecommended BrS drug use was identified comparing time before BrS diagnosis (12.6%) with each of the 5 years following BrS diagnosis (P>0.05). Factors associated with any nonrecommended BrS drug use after diagnosis were female sex (hazard ratio [HR]) 1.83 [95% CI, 1.15-2.90]), psychiatric disease (HR, 3.63 [1.89-6.99]), and prior use of any nonrecommended BrS drug (HR, 4.76 [2.45-9.25]). No significant association between any nonrecommended BrS drug use and implantable cardioverter defibrillator therapy (n=20/97, odds ratio [OR], 0.7 [0.2-2.4]), mortality (n=10/270, OR, 3.4 [0.7-19.6]), or the combined end point (n=38/270, OR, 1.7 [0.8-3.7]) was identified. Conclusions One in 3 patients with BrS were treated with a nonrecommended BrS drug after BrS diagnosis, and a BrS diagnosis did not change prescription patterns. More awareness of nonrecommended drug use among patients with BrS is needed.

Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit

ObjectiveTo assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019–June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. ResultsWe reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2–26) at admission and 10 (0–25) at discharge.373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons.Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases).Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). ConclusionsThe integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.

Analysis of drug prescriptions of patients with atrial fibrillation in combination with chronic kidney disease for compliance with STOPP/START criteria

The percentage of elderly and senile patients is growing every year. Among this cohort of patients, atrial fibrillation (AF) is one of the most common rhythm disorders. At the same time, AF repeatedly increases the risk of thromboembolic complications. The course of AF in elderly patients is often complicated by chronic kidney disease (CKD). When managing patients of this group, we often encounter polypragmasia, which affects the patient’s quality of life, increases the risk of falls, and potentially reduces life expectancy. In order to optimize pharmacotherapy, STOPP/ START criteria were developed.The purpose of the study was the analysis of drug prescriptions in patients over 65 years of age with AF and CKD for compliance with the STOPP/ START criteria.Material and methods. 339 case histories of the cardiology department and 180 case histories of patients of the therapeutic department of the Veterans of Wars multidisciplinary hospital were analyzed. In each department, patients were divided into 2 groups: patients with AF in combination with CKD C3a and patients with AF in combination with CKD C3b and C4.Results. In the therapeutic department, 96.1% of the first group and 100.0% of the second group of patients were not prescribed drugs that are recommended for elderly patients (START criteria). 64.7% of patients from the first group and 53.8% of patients from the second group have potentially not recommended, but prescribed drugs (STOPP criteria) in the appointment lists In the cardiology department, the percentage of patients who did not have the recommended drugs (START criteria) in drug therapy was 92% in group 3, 97% in group 4. The percentage of patients who were prescribed potentially non-recommended drugs (STOP criteria) in group 3 45%, in group 4 48%.Conclusion. Most elderly and senile patients with AF in combination with CKD have both START and STOPP criteria, which dictates a thorough analysis of the prescribed drug therapy.

Analysis of the structure of drug prescriptions in patients with arterial hypertension and atrial fibrillation in conditions of comorbidity and their compliance with the STOPP/START criteria

Background. Arterial hypertension (AH) is often associated with type 2 diabetes mellitus (DM2), is one of the leading modifiable risk factors for cardiovascular disease, atrial fibrillation (AF), chronic kidney disease (CKD). Progression of renal dysfunction is a powerful predictor of the onset of AF in patients with high blood pressure. Irrational prescription of drugs is a risk factor for adverse drug reactions, which is especially important for elderly patients and leads to an increased risk of adverse clinical outcomes.Objective. To analyze the concordance of pharmacotherapy with the STOPP/START criteria in comorbid elderly patients with AH and combined DM2, CKD and AF treated in a multidisciplinary hospitals.Design and methods. Included data from medical records of 1600 patients aged ≥ 65 years with AH and/or AF admitted to multidisciplinary hospitals in Moscow from July 1, 2018 to June 30, 2019. Patients were divided into two groups — (1) AH in combination with AF (n = 822, women — 73%, median age 87 [79; 90]) and (2) control group (n = 778, women — 79,9%, median age 78 [71; 85]) Evaluation of the appointment of drugs was made according to the “STOPP/START” criteria.Results. The number of patients who were not prescribed the recommended drugs was statistically significant (p &lt; 0,001) and higher in the AH + AF group (785 people, 95,5%) compared to the control group (623 people, 80,1%). The number of patients who were prescribed potentially non-recommended drugs was similarly statistically significant (p &lt; 0,001) higher in the AH + AF group (439, 53,4%) compared to the control group (328, 42,2%). The most common START criteria were: 1. Statins with a documented history of coronary, cerebral or peripheral vascular disease (in the AH + AF group — 672, 81,8% of the number of patients in the group; in the control group — 464, 59,6%; p &lt; 0,001) 2. Clopidogrel in patients with ischemic stroke or a history of peripheral vascular disease (c respectively, 324, 39,4% and 237, 30,5%; p &lt; 0,001) 3. Warfarin/direct oral anticoagulants in AF (in the group AG + FP — 294, 35,8%). The most common STOPP criteria were: 1. Drugs that can increase constipation in chronic constipation, if there is a more suitable alternative (in the AH + AF group — 160, 19,5% of the number of patients in the group; in the control group — 47,6%; p &lt; 0,001). 2. Drugs with anticholinergic activity in chronic constipation (respectively, 111, 13,5% and 74, 9,5%; p = 0,013). 3. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with hyperkalemia (respectively, 26, 3,2 % and 94, 12,1%; p &lt; 0,001). Similar results were obtained in the analysis of subgroups of AH + AF with concomitant DM2, CKD and without them.Conclusions. The results obtained dictate the need to optimize pharmacotherapy in elderly and very old patients with AH and comorbidities in a hospital setting. In practice, START criteria are more common than STOPP, that is, in reality, the necessary drugs are often not prescribed where they are indicated and drugs with an unfavorable safety profile are prescribed relatively rarely in elderly and senile patients.

Use of non-recommended drugs in Brugada Syndrome: a Danish nationwide cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Background To lower the risk of sudden cardiac death, patients with Brugada Syndrome (BrS) are recommended to avoid intake of drugs known to increase the risk of arrhythmias or the development of type-1 BrS ECG. However, information on adherence to these recommendations among patients with BrS is limited. Purpose To examine treatment with non-recommended drugs before and after diagnosis with BrS, risk factors of treatment with these drugs, and whether treatment was associated with a higher risk of hospitalization with ventricular arrhythmias or death. Methods All patients diagnosed with BrS in Denmark (1995-2018) with &amp;gt;12 months of follow-up were identified through nationwide registries using the ICD-10 diagnosis code DI472M (PPV 95.8%). Relevant BrS risk drugs were identified and grouped as drugs to "avoid" or "preferably avoid" in agreement with the likelihood of promoting arrhythmias and type-1 BrS ECG according to brugadadrugs.org(1) (accessed August 2021). Multiple logistic regression (adjusted for sex, age, year of diagnosis, and relevant comorbidities and drugs) was performed to identify factors associated with risk drug use during follow-up. Results We identified 270 patients with BrS. Median age at the time of diagnosis was 46.2 years [IQR 32.6-57.6], 70.4% were male. Before the time of diagnosis, 16 patients (5.9%) were treated with a drug to "avoid" or "preferably avoid" (n=5 and n=12, respectively). During a median follow-up of 79 months, 89 patients (33%) were treated with at least one BrS risk drug after the time of diagnosis (table). A total of 22 patients with BrS (8.1%) received ≥2 different drugs at any time during follow-up. There was no significant difference in proportions of patients receiving a risk drug the year prior to diagnosis (12.2%) compared to each of the five years following diagnosis (year 1-5, respectively: 12.2%; 9.7%; 12.3%; 13.6%; 13.5% (p&amp;gt;0.05 for all)). Females had an odds ratio (OR) of 2.21 [95% CI 1.21-4.03] for use of risk drugs. Also associated with a greater likelihood of risk drug use after diagnosis were having a psychiatric disease at baseline (OR=4.80 [1.72-13.41]) and any use of a risk drug within 90 days prior to diagnosis (OR=8.54 [2.13-34.31]) (figure). During follow-up, six patients were hospitalized for ventricular arrhythmias; none had redeemed a prescription of a risk drug. In total, 12 patients died, of which five (41.7%) had redeemed a prescription of one or more risk drugs within 50 days of death. Conclusions 1/3 patients with BrS received a risk drug at any time point after diagnosis. No change in proportions of patients treated with risk drugs was identified after time of diagnosis. 5/12 patients that died during follow-up had redeemed a prescription of one or more risk drugs within 50 days of death. Female sex, any psychiatric diagnosis, and use of a non-recommended drug before diagnosis with BrS were associated with a greater likelihood of risk drug use after diagnosis.

Evolving patterns of antiretroviral drug interactions in people with HIV in British Columbia, Canada.

To characterize the annual prevalence of antiretroviral/nonantiretroviral drug interactions in relation to antiretroviral therapy (ART)-prescribing patterns, and to describe drug interaction-related ART changes. This cohort study included ART-treated adults in British Columbia, Canada between 01 January 2010 and 31 December 2016. Medication dispensing records were abstracted from a population-based, linked administrative-health dataset and used to identify antiretroviral-comedication drug interactions ('caution'/'avoid' drug interactions in HIV-focused drug interaction checkers). We identified temporal trends in annual drug interaction prevalence and quantified the association between taking higher drug interaction-risk ART and receiving nonrecommended antiretroviral-comedication combinations using Poisson regression models, modified for binary outcomes and correlated data. Clinician-reported, drug interaction-related ART changes and associated adverse events were abstracted from an HIV drug treatment registry and summarized descriptively. Among 8571 ART-treated adults who received nonantiretroviral comedications, prevalence of having any drug interaction or receiving nonrecommended drug combination(s) significantly declined from 85 to 71% and 5.6 to 3.2%, respectively, between 2010 and 2016 ( P < 0.001). This paralleled a shift from higher drug interaction-risk ART (e.g. ritonavir/cobicistat-boosted protease inhibitors) to lower drug interaction-risk ART (e.g. unboosted integrase inhibitors). Risk of receiving a nonrecommended antiretroviral-comedication combination was greater for persons taking higher vs. lower drug interaction-risk ART [adjusted risk ratio (aRR) 3.12, 95% confidence interval (CI) 2.24-4.35]. Boosted antiretroviral-inhaled corticosteroid drug interactions accounted for the most commonly dispensed, nonrecommended drug combinations, and the most commonly reported drug interaction-related adverse events (adrenal insufficiency). The prevalence of antiretroviral-comedication drug interactions is declining as ART shifts towards antiretrovirals with lower drug interaction potential but nonrecommended drug combinations remain a concern. Healthcare providers should screen for drug interactions whenever drugs are prescribed or dispensed.

Polymorbidity and Polypragmasia in High and Very High Cardiovascular Risk Patients

Aim. Assessment of the level and structure of polymorbidity, features of pharmacotherapy therapy in patients of different age groups, belonging to the category of high and extremely high cardiovascular risk, observed in outpatient clinics.Material and methods. The single-stage study included 282 patients of high and very high cardiovascular risk who were divided into three groups: (1) age 45-59 years, (2) 60-74 years, (3) ≥75 years. The structure of polymorbidity and features of pharmacotherapy in different age groups patients were evaluated. The frequency of polypragmasia was determined, and treatment adequacy in patients over 65 years of age was analyzed using the STOPP / START criteria and the Beers criteria of 2019.Results. High and very high cardiovascular risk patients have been found to be highly polymorbid, polimorbidity level increasing with age. Thus, among elderly patients, ischemic heart disease, chronic heart failure (CHF) were more often detected, as well as a high frequency of concomitant and background conditions, especially bone and joint system involvement (osteoarthritis, rheumatoid arthritis). Polypragmasia (administration of ≥5 drugs) was detected in 150 patients (53.2%) and was more common among elderly patients. According to Beers criteria, there were 48 cases of inadequate medication prescribing in 46 (28.0%) elderly patients. According to 80 STOPP criteria, 75 cases of prescribing potentially non-recommended drugs to 55 patients (32.1%) were detected. According to 34 START criteria, 116 cases of non-prescribing of necessary drugs to 52 (30.4%) elderly patients were found. When assessing the frequency of prognosis modifying medication prescribing, patients with CHF in 107 (63.0%) cases received angiotensin converting enzyme inhibitors, and in 42 cases (24.5%) angiotensin II receptor antagonists had been prescribed. Thus, 87.5% CHF patients were receiving renin-angiotensin-aldosterone system blockers. Statins were administered in 225 (79.8%) cases, antiplatelet agents were pre-scribed in 157 (67.9%) cases, and 23 persons (9.9%) were on oral anticoagulants for atrial fibrillation.Conclusion. In the structure of the studied cohort most of the high and very high cardiovascular risk outpatients were polimorbid, elderly and senile. Polypragmasia has been detected in more than half of elderly outpatients (53%), irrational medication was found in 28% to 30% elderly patients. Most patients with CHF were on statins, antithrombotic therapy, and renin-angiotensin-aldosterone system blockers.

Indications for prescription and deprescription in multimorbid independently living elderly outpatients

Abstract Introduction Global trend to population ageing is associated with inevitable increase of polypharmacy in multimorbid elderly population. Purpose To estimate the level and structure of comorbidity and pharmacotherapy in independently living patients of different age groups with high and extreme cardiovascular risk, when observed in outpatient clinics Methods 282 consecutive patients of high cardiovascular risk have been enrolled. Inclusion criteria were: SCORE ≥5%, documented history of acute myocardial infarction (AMI), acute or transient cerebrovascular accident (CVD), coronary artery intervention, acute coronary syndrome (ACS), stable angina, intermittent claudication, type 2 diabetes mellitus (DM2) or type 1 DM with diabetic nephropathy, angiogram or ultrasound proved atherosclerotic plaques, total serum cholesterol level ≥8 mmol/L, blood pressure ≥180/110 mmHg and signed voluntary informed consent form. Current clinical conditions, pharmacologic treatment and indications for prescription and deprescription were studied. STOPP criteria for prescribing potentially non-recommended drugs in people over 65 years of age, START criteria for not prescribing necessary drugs in people over 65 years of age, non-recommended in elderly people over 65 drug list were used to assess polypharmacy. According to the WHO age classification, there were three groups: Group 1 (aged 45 to 59), Group 2 (aged 60 to 74) and Group 3 (aged 75 +). Results There were no differences in the frequency of statins administration (p=0.72) and antiplatelet agents (p=0.49) between 3 groups. Polypragmasia (administration of more than 5 drugs) was registered in 150 patients (53%) and was significantly more common in Group 3 (p=0.001). 48 cases of inadequate prescribing were registered in 46 (28%) elderly patients. 24 cases of prescribing potentially unacceptable medications for the elderly were reported. Conclusion Unavoidable polypragmasia was found in 53% multimorbid elderly patients. Irrational drug treatment was detected in 28% elderly patients STOPP criteria were met in 32.1% and START criteria were met in 30.4% cases. Polypragmasia being inevitable in elderly multimorbid patients, administration of any new medication should be performed after a thorough risk-benefits balance assessment. Funding Acknowledgement Type of funding sources: None.

Aspects of practical application of ‘STOPP/START’ criteria in elderly patients with atrial fibrillation and chronic kidney disease in therapeutic department of multi‑speciality hospital

Introduction. Polypharmacy and the administration of potentially non-recommended drugs are the causes of adverse drug reactions. The absence of potentially recommended drugs leads to a decrease in the duration and quality of life, an increased risk of complications from various organs and systems.The purpose of the study. To analyze the structure of prescribed drugs in patients over 65 years of age with atrial fibrillation (AF) and chronic kidney disease (CKD) stages 3 and 4 for the presence of рolypharmacy and compliance of prescriptions with the criteria STOPP/START.Materials and methods. 125 case histories were analyzed in patients 65 years and older with AF and CKD. Patients were divided into two groups: group 1 – patients with AF and CKD 3a (n = 51; 84.3 % of women; mean age 86.1 ± 6.4 years; mean score on the CHA(2) DS(2)-VASc scale 6.2 ± 1.1 points; mean score on the HAS-BLED scale 3.00 ± 0.68 points); group 2 – patients with AF and CKD 3b and 4 stages (n = 39; 84.6 % of women; mean age 87.9 ± 4.7 years; mean score on the CHA(2) scale; DS(2)-VASc 6.1 ± 1.2 points; the average score on the HAS-BLED scale is 3.10 ± 0.71 points). All 100 % of patients in both groups had a high risk of stroke on the CHA(2) DS(2)-VASc scale (≥ 2 points for men; ≥ 3 points for women), 82.4 % of patients in group 1 and 79.5 % of patients in group 2 had a high risk of bleeding on the HAS-BLED scale (≥ 3 points). According to the prescribing sheets of medical histories, the frequency of polypharmacy was evaluated, as well as the structure of drug prescriptions according to the STOPP/START criteria.Results. The number of patients who were prescribed ≥5 drugs was 100 % in group 1 and 94.9 % in group 2. The number of patients receiving ≥10 drugs at the same time was 11.8 % and 20.5 % in group 1 and 2, respectively. In 64.7 % of patients from group 1 and in 53.8 % of patients from group 2, potentially non-recommended but prescribed drugs (STOPP) are present in the prescribing lists. At the same time, 96.1 % and 100 % of patients in groups 1 and 2, respectively, were not prescribed drugs that are recommended for elderly patients (START criteria).Conclusion. Patients with AF and CKD aged 65 years and older are often prescribed potentially non-recommended drugs that significantly reduce the quality of life and increase the risk of adverse drug reactions. These patients were also often not prescribed potentially recommended drugs that are necessary to improve the prognosis, reduce the risk of complications, and reduce the number of hospitalizations. The revealed facts dictate the need to optimize pharmacotherapy in elderly and senile patients with AF and CKD in a hospital setting.

Фармакоэпидемиологический анализ применения лекарственных препаратов у пожилых пациентов с гипертонической болезнью на стационарном уровне

This article analyzes the frequency of prescribing drugs to elderly patients according to Beers criteria, who are in-patient treatment in the therapeutic department. 50 case histories of patients over 65 years of age over a three-month period were analyzed: from January to March 2019. The appointment sheets were analyzed using the Beers list to identify the destination of potentially not recommended drugs. According to the results of the study, it was revealed that on average 8±2 drugs were prescribed to one patient at a time, all drugs were prescribed under trade names, some of them were prescribed without indications for use. In 14 patients (28.4%), 25 non-recommended drugs were identified in different categories according to Beers criteria, where 13.6 potentially identified recommended drugs were detected in 13.6% of patients, and 5 potentially not recommended drugs were prescribed in 5.7% of patients, the use of which should be avoided in older people with certain diseases, and in 9.1% of patients 8 drugs were identified that should be used in older people with great care. All of the above allowed us to conclude that in the treatment of elderly patients, potentially not recommended medications are very often prescribed, because of which there is a risk of developing unwanted side reactions.

Drugs Used for Euthanasia: A Repeated Population-Based Mortality Follow-Back Study in Flanders, Belgium, 1998–2013

ContextAccording to guideline recommendations, barbiturates and neuromuscular relaxants are the recommended drugs for euthanasia. ObjectivesTo describe changes over time in drugs used to perform euthanasia and differences in case characteristics according to the drugs used. MethodsRepeated population-based mortality follow-back study among physicians attending a large representative sample of deaths in 1998, 2007, and 2013 in Flanders, Belgium. ResultsIn 1998, we identified 25 euthanasia cases (1.2% of all deaths), 142 cases in 2007 (2.0% of all deaths), and 349 cases in 2013 (4.6% of all deaths). Use of recommended drugs to perform euthanasia increased from 11.9% of euthanasia cases in 1998 to 55.3% in 2007 and 66.8% in 2013 (P < 0.001). In 2013, cases with recommended drugs compared with nonrecommended drugs more often involved requests expressed both orally and in writing (86.8%/14.1%; P < 0.001), consultation with colleague physicians (93.8%/69.1%; P < 0.001), and administration in the presence of another physician (98.3%/54.3%; P < 0.001), and were more often self-labeled by physicians as euthanasia (95.5%/0.9%; P < 0.001) and reported to the euthanasia review committee (92.3%/3.8%; P < 0.001). Between 2007 and 2013, physicians consistently labeled cases in which nonrecommended drugs were used as palliative sedation (72.8%/78.4%; P = 0.791) or alleviation of pain and symptoms (13.2%/15.0%; P > 0.999). ConclusionPhysicians in Flanders are increasingly using the recommended drugs for euthanasia. This suggests that guidelines and training regarding the conduct and pharmacological aspects of euthanasia may have had important effects on the practice of euthanasia. However, the declining but persisting use of nonrecommended drugs requires further attention.

Unsafe Drug Use and Arrhythmic Events in Brugada Patients with ICD: Results of a Long-Term Follow-Up.

Brugada syndrome is a hereditary disease linked with an increased risk of sudden death that may require an implantable cardioverter-defibrillator (ICD) in order to halt the arrhythmic events. The aim of this study was to identify possible triggers for appropriate ICD therapies in patients with Brugada syndrome, focusing on their past and current therapeutic profiles. Thirty patients with high-risk Brugada syndrome, with ICD implanted at the Coimbra Hospital and University Center, were enrolled. Patients were questioned about their Brugada syndrome history, previous cardiac events, comorbidities, present and past medications, and physical activity. Patients were followed up during 5.8 ± 5.3years. The ICD was interrogated, and arrhythmic events and device therapies were recorded. The cohort who received appropriate ICD therapies was compared with the remaining patients to determine the potential link between clinical variables and potentially fatal arrhythmic events. More than half of the patients (53.3%) took at least one non-recommended drug, and 16.7% received appropriate ICD therapies, with a long-term rate of 4.0%/year. There was a tendency for more appropriate ICD therapies in patients who took unsafe drugs (85.7 versus 45.5%, p = 0.062), and the mean time between unsafe drug intake and appropriate ICD therapies was 3.8 ± 7.5days. This study revealed that the medical community is still unaware of the pharmacological restrictions imposed by Brugada syndrome. Patients who took non-recommended drugs seem to have a higher risk of ventricular arrhythmic events.

A review of urinary tract infection management for patients admitted to the emergency department: Assessment of adherence to guidelines and identification of hospitalization criteria

Background & objectives Community-acquired urinary tract infections (UTIs) are the second most common indication for antibiotic prescription in France. Previous studies on the adherence to guideline on antibiotic use reported a prevalence of inappropriate prescriptions varying from 20 to 50%, both in the community and hospital settings. The misuse of antibiotics not only have an important economic impact but can also lead to therapeutic impasses. This study aimed at establishing the current management of UTIs for patients admitted to the emergency department (ED) of our hospital. Methods This retrospective observational study was conducted in the European Hospital of Marseille January 2015 and May 2016. Consecutive patients admitted to the ED for a suspected UTI were included, including patients hospitalized ( n = 50) or discharged ( n = 50) after their ED admission. Assessment of adherence to guidelines for antibiotic prescription was conducted using the guidelines of the French-speaking society of infectious disease (SPILF). Results In the hospitalized group, 22 (44%) antibiotic prescriptions initiated at the ED did not comply with national guidelines. The two main causes for inappropriate prescriptions were the use of two antibiotics in patients with no severity criteria (15, 68%) and/or the use of a non-recommended drug (6, 27%). In this group, 17 (35%) antibiotic prescriptions ordered by the urologist on patients’ discharge did not comply with national guidelines. The two main causes of inappropriate prescriptions were the use of a non-recommended drug (9, 53%) and an inadequate duration of treatment (9, 53%). In the discharged group, 29 (60%) of the antibiotic prescriptions ordered at the ED did not comply with national guidelines. The two main causes of inappropriate prescriptions were an inadequate duration of treatment (23, 79%) and the use of a non-recommended drug (19, 66%). We could also identify discrepancies between reasons for hospitalization in our cohort compared to the criteria for hospitalization mentioned in the national guidelines. Discussion & conclusions This study has identified areas of improvement for the management of UTIs in our hospital. Our suggestions for optimization include educational materials and a decision tree displayed at the ED and specific therapeutic protocols in our computerized prescription system.

Antimalarial treatment patterns among pregnant women attending antenatal care clinics in south east Nigeria and the future implications

Prompt and effective treatment of malaria in pregnancy in accordance with recommended guidelines is essential to help prevent adverse events among pregnant mothers and the foetus. The aim of this study was to assess current prescribing of antimalarial medicines in pregnancy against policy guidelines in south east Nigeria to provide future guidance. A review of prescription records of pregnant women treated for malaria over a 6-month period between August 2013 and January 2014 was carried out to assess the prescribing patterns for both the prevention and treatment of malaria in each trimester and analyzed for conformity to recommended guidelines. Among 859 antenatal records reviewed, the majority (83.2%) were in the second and third trimesters. Artemisinin-based combination therapies (40.9%) and sulfadoxine-pyrimethamine (37.5%) were the most prescribed antimalarial medicines for both treatment and prophylaxis (prevention), respectively, in all trimesters. Overall, 68.5% of the prescriptions conformed to guideline recommendations, with the prescriptions for non-recommended drugs occurring most often in the first trimester. In the second and three trimesters, up to 79.9% of pregnant women received appropriate medicines for both treatment and prevention of malaria, with artemether-lumefantrine the most prescribed regimen. Current practice indicates greater conformity with guidelines particularly in the second and three trimesters vs previous studies. However, there are still concerns with prescribing practices in the first trimester, especially in private health facilities. This needs addressing.

Prescription of “ineffective neuroprotective” drugs to stroke patients: a cross sectional study in North Indian population

In a developing country, where patient access to tertiary care is limited and most patients have to pay out of pocket, it is imperative for the physicians to practice evidence-based medicine. Reports on prescription details and surveys are not available. The aim of this study is to describe the prescribing patterns for various medications used in the treatment of stroke among the first contact physicians in North India; to estimate the proportion of patients being prescribed the non-recommended drugs and to determine any relationship between the economic status of the patient and the prescription pattern. Details of economic status, education level, type of stroke, type of hospital, qualification of treating physician and the number and nature of medications were noted from the prescriptions and patients. Two hundred and sixteen patients with ischemic stroke (71.3% males, average age 51.5 years) were included. Among poor patients, N = (36.8%) received any of the neuroprotective drugs including citicoline 19 (27.5%), piracetam 11(15.9%) and edaravone 2(2.9%). Both specialist and private hospitals are associated with higher prescription of “ineffective neuroprotective” drugs in both poor and rich patients. Reasons for overprescribing neuroprotective medications need to be studied and remedial measures need to be taken to practice evidence-based medicine.

Rational drug use in patients undergoing cognitive intervention treatment: Prescription profiles and predictors of poorer patient outcomes

While there is evidence on the efficacy of Cognitive Intervention Treatment (CIT) in patients with Cognitive Impairment (CI) secondary to Focal Neurological Damage (FND) and to Neurodegenerative Diseases (ND), the predictors of treatment response have not been fully studied. There are Non-Recommended Drugs (NRD) for patients with CI, such as anticholinergic agents, barbiturates, and benzodiazepines. The objectives were to describe the drug prescription profile in patients undergoing CIT; to evaluate the use of NRD; and to compare the outcomes between patients who received NRD and patients who did not receive them. Patients with CI secondary to FND and ND were enrolled in an outpatient CIT program (n=219). The sample was divided into 2 groups: patients that received NRD (n=85) (G1), and patients that did not receive NRD (n=134) (G2). The groups were paired by age, education, Mini Mental State Examination, Beck Inventory (BI), time of progression, and number of sessions. Cognitive variables, behavioral variables, Activities of Daily Living (ADL) and Quality of Life (QoL) were compared at treatment start and treatment end. Parametric statistics and analysis were performed at paired samples. Drug-use rates were as follows: 37% antiplatelet aggregating agents, 32.9% antidepressant agents; 21% cholinesterase inhibitors (60.9% donezepil), 22.4% antiepileptic agents, 20.1% antipsychotic agents (60.5% quetiapine), and 17.4% memantine. Regarding NRD: 32.9% (n=72/219) received benzodiazepines, 4.6% (n=10/219) anticholinergic agents, and 2.28% (n=5/219) were administered barbiturates. At CIT end, G1 only evidenced improved QoL (mean change (MCh)=4.78;p:0.01). G2 exhibited improved Subjective Memory (MCh=5.74;p:0.03), basic ADL (MCh=1.4;p:0.009) and instrumental ADL (MCh=1.08;p:0.01), BI (MCh=1.9;p:0.01), and Neuropsychiatric Inventory (MCh=6.12;p:0.01). A significant number of patients with CI received NRD. CIT led to significant improvement at some of the study variables, with a lower effect on patients who received drugs with prejudicial effects on cognition.