Polypharmacy and patterns in drug prescribing at a primary healthcare centre in the Riyadh region of Saudi Arabia

Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia

Background

Cardiovascular disease is the leading cause of death and disability worldwide. It is a general term used to describe a group of disorders that affect the heart or blood vessels. This study aimed to evaluate the prevalence and predictors of polypharmacy in patients with heart failure.

Methods

We conducted a cross-sectional study in a tertiary hospital in Saudi Arabia. Data was extracted from an electronic database between January 2019, and December 2022. The study included all adult patients with heart failure who visited outpatient clinics; individuals with cancer were excluded. The outcome variable in our study was "polypharmacy" which was defined as the use of eight or more medications. Descriptive analysis was performed using frequencies and percentages for categorical variables. In addition, Multivariate logistic regression was used to assess the covariates associated with polypharmacy.

Results

A total of 331 patients with heart failure were included in this study. The prevalence of polypharmacy among our HF population was 39.88 %. Most participants were male (60.73 %), and 60 years or older (68 %). The most frequently used medications were beta-blockers (67.98 %) and diuretics (58.31 %), whereas the least frequently used medications were hydralazine and histamine H2 blockers (5.74, and 3.02 %, respectively). Polypharmacy was likely to be a non-significantly higher in individuals aged between 60 and 69 years (adjusted odds ratio (AOR) = 1.52; 95 % confidence interval (CI) 0.78-2.98) and suffering from hypertension (AOR = 1.48; 95 % CI 0.83-2.64). However, patients with heart failure and diabetes mellitus had a significant six-fold higher of polypharmacy than those without diabetes mellitus (AOR = 6.55; 95 % CI 3.71-11.56).

Conclusion

Patients with heart failure often use multiple medications. Patients with heart failure together with diabetes have a higher risk of polypharmacy. Therefore, healthcare professionals should manage polypharmacy to improve the outcomes in patients with heart failure.

Metformin Use Is Not Associated With B12 Deficiency or Neuropathy in Patients With Type 2 Diabetes Mellitus in Qatar

BACKGROUND

Metformin may lead to B₁₂ deficiency and neuropathy. There are no published data on the prevalence of Metformin-related B₁₂ deficiency and neuropathy in the Arabian Gulf.

AIMS

Determine whether Metformin intake is associated with B₁₂ deficiency and whether B₁₂ deficiency is associated with diabetic peripheral neuropathy (DPN) and painful diabetic neuropathy.

METHODS

Patients with type 2 diabetes mellitus (T2DM) (n = 362) attending outpatient clinics at HMC underwent assessment of B₁₂ levels, the DN4 questionnaire, and vibration perception threshold (VPT).

RESULTS

Comparing Metformin to non-Metformin users there were no differences in B₁₂ levels, VPT, or DN4. The prevalence of B₁₂ deficiency (B₁₂ <133 pmol/l) was lower (P < 0.01) in Metformin (8%) compared to non-Metformin (19%) users. Patients with B₁₂ deficiency had a comparable prevalence and severity of sensory neuropathy and painful neuropathy to patients without B₁₂ deficiency.

CONCLUSION

Serum B₁₂ levels were comparable between Metformin and non-Metformin users with T2DM in Qatar. T2DM patients on Metformin had a lower prevalence of B₁₂ deficiency. Furthermore, the prevalence and severity of neuropathy and painful diabetic neuropathy were comparable between patients with and without B₁₂ deficiency.

A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain

OBJECTIVE

To investigate the association between polypharmacy and sociodemographic factors as well as health status, determinants of health and healthcare use, illness and use of prescribed medicines amongst adults in Spain.

METHODS

Data from the 2009 European Health Interview Survey in Spain which included 22 188 subjects were used. Polypharmacy was defined as the use of five or more prescribed medicines. The association between polypharmacy and several variables was assessed by means of bivariate analysis and logistic regression analysis (adjusted by age and gender).

KEY FINDINGS

Amongst study participants, 15.8% were on prescribed polypharmacy (19.3%, women; 10.3%, men (P < 0.001)). A number of sociodemographic factors (e.g. age, gender, educational level), health status factors (e.g. limitation in daily activities, self-perception of health, presence of chronic disease) and other health-related factors (e.g. smoking, alcohol drinking, physical activity) have been studied and have been found to play a role in polypharmacy. Logistic regression analysis provided three variables which together with age could be used to predict polypharmacy.

CONCLUSION

In Spain, approximately 16% of people who take medicines are on polypharmacy and this is more frequent in women and amongst older adults. From our study, we can conclude that the variables which can predict a higher likelihood of polypharmacy are, together with age, prescribed antidepressants, and prescribed medicines for back/neck pain and joint pain. This may provide a tool for health professionals to readily assess polypharmacy appropriateness in polymedicated patients.

Historical perspective of traditional indigenous medical practices: the current renaissance and conservation of herbal resources

In recent years, increasing numbers of people have been choosing herbal medicines or products to improve their health conditions, either alone or in combination with others. Herbs are staging a comeback and herbal “renaissance” occurs all over the world. According to the World Health Organization, 75% of the world's populations are using herbs for basic healthcare needs. Since the dawn of mankind, in fact, the use of herbs/plants has offered an effective medicine for the treatment of illnesses. Moreover, many conventional/pharmaceutical drugs are derived directly from both nature and traditional remedies distributed around the world. Up to now, the practice of herbal medicine entails the use of more than 53,000 species, and a number of these are facing the threat of extinction due to overexploitation. This paper aims to provide a review of the history and status quo of Chinese, Indian, and Arabic herbal medicines in terms of their significant contribution to the health promotion in present-day over-populated and aging societies. Attention will be focused on the depletion of plant resources on earth in meeting the increasing demand for herbs.

Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

Objective:

The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients.

Materials and Methods:

A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18.

Results:

Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP.

Conclusion:

We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.

Avaliação de interações medicamentosas potenciais em prescrições da atenção primária de Vitória da Conquista (BA), Brasil

As interações medicamentosas são fatores de risco para a ocorrência de reações adversas a medicamentos. Este estudo teve o objetivo de avaliar as interações medicamentosas potenciais em prescrições da atenção primária de Vitória da Conquista (BA), visando preencher a lacuna de conhecimento sobre essa temática no Brasil. Foram coletadas informações sobre diversas variáveis de prescrições oriundas da atenção primária e as interações medicamentosas avaliadas a partir dos bancos de dados do Medscape e Micromedex(r). Verificou-se ainda a frequência de polifarmácia e associação desta com a ocorrência de interações medicamentosas. Os resultados mostraram frequência de 48,9% de interações medicamentosas, 74,9% delas de gravidade moderada ou maior, e 8,6% de prescrições em polifarmácia que, em teste qui-quadrado, mostrou associação positiva com ocorrência de interações medicamentosas potenciais (p < 0,001). As prescrições oriundas da atenção primária de Vitória da Conquista (BA) apresentaram uma alta frequência de interações medicamentosas, porém faz-se necessária a análise de outros fatores de risco para ocorrência destas nesse nível de atenção à saúde.

Characteristics of Saudi patients with congestive heart failure and adherence to management guidelines in a tertiary hospital in Riyadh

BACKGROUND AND OBJECTIVES

There is limited data available on the characteristics of local Saudi patients diagnosed with congestive heart failure (CHF) and on their adherence to guidelines for managing the disease. This study aimed to fill this gap.

DESIGN AND SETTING

Retrospective study of patients treated at King Abdulaziz Medical City from 20022008.

SUBJECTS AND METHODS

The records were reviewed of subjects admitted secondary to heart failure (defined as systolic heart failure [ejection fraction < 55%] and/or heart failure with preserved ejection fraction diagnosed either clinically and/or by echocardiogram and/or cardiac catheterization) or who visited the outpatient department for the same complaint.

RESULTS

Of 392 CHF cases, the mean age was 67.8 (12.8) years and the majority were males (53.1%). Hypertension was the predominant comorbid illness, accounting for 84.9% of cases, followed by diabetes mellitus type 2 and hyperlipidemia. Almost three-fourths (73.7%) of the subjects had mild to severe left ventricular dysfunction, with 68.5% of the cases having right ischemic cardiomyopathy. Spironolactone, exercise and vaccination were the the least least adhered to recommendations (30.0%, 20.5% and 15.2%, respectively).

CONCLUSIONS

The study highlights the need for proper education of patients and caregivers to increase compliance to medications. Physicians are also encouraged to undergo continuing medical education and training courses to properly implement current recommendations in the management of heart failure. Further studies are needed on a larger scale in order to formulate an effective management scheme that will address the current challenges faced by both clinicians and CHF patients.