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Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care. Eur J Clin Pharmacol 2024; 80:603-612. [PMID: 38319349 PMCID: PMC10937751 DOI: 10.1007/s00228-024-03633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person's Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria. METHODS A retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient. RESULTS The mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0-66.6%), 66.8% (95% CI 64.1-69.5%), and 50.1% (95% CI 47.2-53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6-32.9) and Beers criteria (30.1%, 95% CI 27.6-32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4-11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735). CONCLUSION This study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.
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Affiliation(s)
- Daniela A Rodrigues
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal
- PhD Student, University of Salamanca, 37007, Salamanca, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007, Salamanca, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001, Madrid, Spain
| | - Fátima Roque
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal.
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal.
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Anlay DZ, Paque K, Van Leeuwen E, Cohen J, Dilles T. Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review. Br J Clin Pharmacol 2024; 90:12-106. [PMID: 37697479 DOI: 10.1111/bcp.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion. METHODS Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines. RESULTS From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence. CONCLUSIONS Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.
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Affiliation(s)
- Degefaye Zelalem Anlay
- End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kristel Paque
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- HAST, Hasselt, Belgium
| | - Ellen Van Leeuwen
- Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences & Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Tinne Dilles
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Stuhec M, Hahn M, Taskova I, Bayraktar I, Fitzgerald I, Molitschnig L, Tatarević A, Lindner N, Agnoletto L, da Costa FA. Clinical pharmacy services in mental health in Europe: a commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health. Int J Clin Pharm 2023; 45:1286-1292. [PMID: 37755642 PMCID: PMC10600282 DOI: 10.1007/s11096-023-01643-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
A large proportion of the world's disease burden is attributable to mental illnesses. Although effective interventions are available, many patients still have limited access to evidence-based treatments. Aside from access, treatment gaps, including inappropriate medication selection and monitoring, are also routinely recognised. Mental health clinical pharmacists can help address these gaps and enable patients to receive optimised pharmaceutical care, particularly appropriate medication selection and monitoring. The European Society of Clinical Pharmacy (ESCP) Special Interest Group on Mental Health was established to improve standardised service provision in mental health settings across Europe. The Special Interest Group identified significant barriers (predominantly associated with reimbursement and position within the multidisciplinary team) to effective pharmaceutical care amongst those with mental illnesses. This commentary presents recommendations to address these gaps through improved mental health clinical pharmacy service provision.
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Affiliation(s)
- Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia.
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia.
| | - M Hahn
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - I Taskova
- Psychiatric Hospital Bohnice, Prague, Czech Republic
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - I Bayraktar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - I Fitzgerald
- Pharmacy Department, St Patrick's University Hospital, Dublin 8, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - L Molitschnig
- Pharmacy Department, Hospital of Elisabethians, Graz, Austria
| | | | - N Lindner
- Pharmacy Department, Vienna General Hospital-Medical University Campus, Vienna, Austria
| | - L Agnoletto
- Hospital Pharmacy, Rovigo Hospital, Rovigo, Italy
| | - F Alves da Costa
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Potentially inappropriate medication prescribing among elderly patients with cardiovascular diseases. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200623118s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The growing number of older adults means higher medicine utilization. The aim of the study was to determine the frequency and identify risk factors of potentially inappropriate medication (PIM) in the elderly population with cardiovascular diseases. Methods. The retrospective, cross-sectional study was performed in 2018, and the relevant data were collected during the period from January 2016 to December 2017. The study sample included 1,500 patients over 65 years with cardiovascular disease who had medical records at the Institute for Gerontology and Palliative Care, Belgrade. Assessment of PIM was done by standard international criteria such as the American Geriatrics Society 2015 updated Beers Criteria for PIM use in older adults. Results. PIM frequency in the elderly population was 70.3%. In relation to gender, it was more frequent in female elders. The mean number of prescribed drugs was similar for 2016 and 2017, 7.2 and 7.3, respectively. The most common were: medium-acting benzodiazepines (70.9%), central ? blockers (23.98%), and antipsychotics (typical and atypical) (20.94%). The most common comorbidity was noted in a group labeled with the International Disease Classification I00-I99, which includes heart and blood vessel diseases [n = 2,658 (36.9%)]. The most common diagnoses belonged to the subgroups I10-I15 [hypertensive diseases, n = 1,298 (18%)], I20-I25 [ischemic heart diseases n = 542 (7.5%)], I30-I52 [other forms of heart disease, n = 705 (9.8%)], I60-I69 [cerebrovascular diseases, n = 94 (1.3%)], and I80- I89 [diseases of veins, lymph vessels, and lymph nodes n = 12 (0.17%)]. The risk factors for PIM were: polypharmacy, gender, nicotine use, cognitive status, nutrition state, and the number of diseases registered in the study sample. Conclusion. Cardiovascular diseases in the elderly population are associated with a high prevalence of PIM. Creating health recommendations for prescribing drugs to the elderly that would emphasize these factors could reduce the prevalence of PIM in this population.
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Rodrigues DA, Plácido AI, Tavares AB, Azevedo D, Mateos-Campos R, Figueiras A, Herdeiro MT, Roque F. Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal. Curr Ther Res Clin Exp 2022; 97:100681. [PMID: 35937773 PMCID: PMC9350873 DOI: 10.1016/j.curtheres.2022.100681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/04/2022] [Indexed: 10/25/2022] Open
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Yasky AF, Zawawi AH. Characterization of potentially inappropriate medication prescriptions for the elderly in primary care and hospital settings. J Family Med Prim Care 2021; 10:3111-3115. [PMID: 34660455 PMCID: PMC8483109 DOI: 10.4103/jfmpc.jfmpc_271_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022] Open
Abstract
Background Polypharmacy cannot be defined numerically due to its varied definitions, and inclusion of comorbidities aggravates the dilemma, creating challenges for the healthcare system and the patients' course of treatment. The introduction of the potentially inappropriate medication (PIM) list developed by the American Geriatrics Society (AGS) (AGS Beers Criteria®; updated in 2019) was deemed a solution. However, several risk factors are associated with PIMs, including increased emergency room visits, hospitalization and mortality, and a decline in daily activity. Differences in PIM prescription rates have been reported; however, with the recent Beers criteria update, the number of patients exposed to PIMs is expected to increase significantly due to the addition of new medications to the list. Objectives This study aimed to describe the characteristics of PIM prescriptions for the elderly in primary care and hospital settings. Methods Medications for elderly patients prescribed in our hospital between 2016 and 2019 were reviewed and sorted based on Beers criteria to identify patients with the most PIMs. Correlations were made between gender and facility. Results This study included 40,168 patients (51% males). The total and average numbers of PIM per elderly patient were 260,753 and 6.5, respectively. Proton pump inhibitors were prescribed the most, followed by nonsteroidal anti-inflammatory drugs. Conclusions We found that increasing numbers of PIMs are prescribed to the elderly in our healthcare facilities. Therefore, further recommendations from local geriatric communities and the implementation of reminders for physicians through electronic prescription systems are needed to decrease the rate of prescribed PIMs.
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Affiliation(s)
- Adel F Yasky
- Department of Family Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Alia H Zawawi
- Department of Family Medicine, King Abdulaziz Medical City, Assistant Professor College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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7
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Yadesa TM, Kitutu FE, Tamukong R, Alele PE. Prevalence, Incidence, and Characteristics of Adverse Drug Reactions Among Older Adults Hospitalized at Mbarara Regional Referral Hospital, Uganda: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1705-1721. [PMID: 34588772 PMCID: PMC8473935 DOI: 10.2147/cia.s332251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Adverse drug reactions (ADRs) are associated with significant clinical and economic effects. Among the elderly population, the risk for ADRs is even higher. Data of ADR prevalence and incidence among the elderly population in Uganda and many low- and middle-income countries are lacking. Objective This study determined the prevalence, incidence, and characteristics of ADRs among hospitalized elderly patients at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods and Materials We conducted a prospective cohort of older adults admitted to medical, oncology, and surgery wards at MRRH for consecutive 6 months. The primary data were obtained by interviewing patients and caregivers and reviewing patient medication charts, taking vital signs, and physical examinations. We used Edwards and Aronson’s definition of ADR and the Naranjo ADR Causality Scale. We conducted descriptive statistics and the Kolmogorov–Smirnov test using SPSS Version 23.0. Results We studied a total of 523 older adults 60 to 103 years of age. During their hospital stay, 256 (48.9%) of the patients experienced at least one ADR. A total of 365 ADRs were identified during 4702 person-days of follow-up. The incidence of ADRs was 78 ADRs/1000 person-days. ADRs affecting the gastrointestinal tract were the most frequently (40.6%) identified categories. Probable and type A ADRs accounted for 260 (71.2%) and 305 (83.6%) of the total incidents, respectively. Overall, 237 (64.9%) of the ADRs were rated as mild, whereas 10 (2.8%) of them as severe. Lastly, 165 (45.2%) of the ADRs were categorized as preventable. Conclusion Almost half of the hospitalized patients aged 60 to 103 years experienced at least one ADR during their hospital stay, which is higher than has been previously documented. Almost three-thirds of the ADRs were probable, about 4 out of 5 were type A and almost two-thirds were mild. Nearly half of the ADRs were preventable.
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Affiliation(s)
- Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pharmacy, Ambo University, Ambo, Ethiopia.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University, Kampala, Uganda.,Sustainable Pharmaceutical Systems (SPS), Makerere University, Kampala, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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8
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Anfinogenova ND, Trubacheva IA, Popov SV, Efimova EV, Ussov WY. Trends and concerns of potentially inappropriate medication use in patients with cardiovascular diseases. Expert Opin Drug Saf 2021; 20:1191-1206. [PMID: 33970732 DOI: 10.1080/14740338.2021.1928632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The use of potentially inappropriate medications (PIM) is an alarming social risk factor in cardiovascular patients. PIM administration may result in iatrogenic disorders and adverse consequences may be attenuated by limiting PIM intake.Areas covered: The goal of this review article is to discuss the trends, risks, and concerns regarding PIM administration with focus on cardiovascular patients. To find data, we searched literature using electronic databases (Pubmed/Medline 1966-2021 and Web of Science 1975-2021). The data search terms were cardiovascular diseases, potentially inappropriate medication, potentially harmful drug-drug combination, potentially harmful drug-disease combination, drug interaction, deprescribing, and electronic health record.Expert opinion: Drugs for heart diseases are the most commonly prescribed medications in older individuals. Despite the availability of explicit and implicit PIM criteria, the incidence of PIM use in cardiovascular patients remains high ranging from 7 to 85% in different patient categories. Physician-induced disorders often occur when PIM is administered and adverse effects may be reduced by limiting PIM intake. Main strategies promising for addressing PIM use include deprescribing, implementation of systematic electronic records, pharmacist medication review, and collaboration among cardiologists, internists, geriatricians, clinical pharmacologists, pharmacists, and other healthcare professionals as basis of multidisciplinary assessment teams.
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Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Irina A Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Elena V Efimova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Russian Federation
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Gonçalves JR, Ramalhinho I, Sleath BL, Lopes MJ, Cavaco AM. Probing pharmacists' interventions in Long-Term Care: a systematic review. Eur Geriatr Med 2021; 12:673-693. [PMID: 33743169 DOI: 10.1007/s41999-021-00469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Long-Term Care (LTC) systems have experienced recent developments driven by changes in healthcare and demography (e.g. population ageing). As well, pharmacists are changing from traditional roles to more patient-oriented services. The present study aimed to identify and assess pharmacists' and/or pharmacy-based interventions in institutional LTC settings, also mapping relevant medications. METHODS The review was undertaken in general accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using three main literature databases (PubMed, Scopus, and Web of Knowledge). A set of 16 keywords, divided into three domains (professional, type of care and type of setting), were combined into search equations. Selected studies were assessed through the Quality Assessment Tool for Quantitative Studies. RESULTS Twenty-six studies met the inclusion criteria, out of 794 initial hits. Most studies (12) described pharmacist/pharmacy-driven interventions assessing Medication Management Reviews' impact in different endpoints or outcomes. Other studies (3) assessed pharmacists' interventions on specific medication groups. Good Administration Practices, new pharmaceutical care models, antibiotic stewardship programs, and studies assessing other pharmacists' interventions, such as pharmacy-managed informatics and education, were addressed by 11 other papers. Six studies were classified as Strong after quality assessment. CONCLUSION LTC is a clinically complex type of care benefiting from interdisciplinary work. Despite the overall lower quality of the identified studies, pharmacists perform in a wide array of LTC areas. The broad implementation of pharmaceutical activities in institutional LTC settings opens opportunities to optimise medicines' use.
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Affiliation(s)
- João R Gonçalves
- iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
| | - Isabel Ramalhinho
- Faculty of Science and Technology, University of Algarve, Campus de Gambelas, 8005-139, Faro, Portugal
| | - Betsy L Sleath
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Manuel J Lopes
- College of Nursing S. João de Deus, University of Évora, 7000-811, Évora, Portugal
| | - Afonso M Cavaco
- iMed.ULisboa, Social Pharmacy Department, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal
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10
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Mangi AA, Hammad MA, Khan H, Arain SP, Shahzad MA, Dar E, Alam A, Hassanein AH. Evaluation of the geriatric patients prescription for inappropriate medications frequency at Larkana Sindh Hospital in Pakistan. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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11
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Oliveira HSBD, Michels AC, Nahime M, Caetano LDM, Corradi MLG. Risk factors associated with potential cardiovascular and cerebrovascular adverse events in elderly individuals assisted at secondary level. Rev Assoc Med Bras (1992) 2020; 66:1087-1092. [DOI: 10.1590/1806-9282.66.8.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/26/2020] [Indexed: 12/26/2022] Open
Abstract
SUMMARY OBJECTIVE To identify the use of Potentially Inappropriate Medications with imminent risk of Cardiovascular and Cerebrovascular Adverse Events (PIM-CCVAE), in addition to the factors associated with a group of elderly individuals undergoing therapeutic care in a Brazilian public service. METHODS A cross-sectional retrospective study conducted at a secondary level service located in Carapicuíba, SP, Brasil. Only elderly individuals (≥60 years) who were treated in one of the outpatient departments were included. The use of PIM-CCVAE was defined based on the PIM-CCVAEs list. In this research, we used descriptive statistics and logistic regression to identify and track possible predictors of MPI use. All statistical analyses were performed using Stata software version 15.1 (Stata Corporation). RESULTS The sample included 233 elderly individuals, with a mean age of 74.9 (± 9.4) years. Of these, 74.2% used at least one PIM-CCVAE, with an average daily intake of 1.3 (± 1) PIM/elderly. The presence of comorbidities, diseases of the circulatory system, polypharmacy, and low to moderate scores in morbidity and mortality were important factors associated with an increased odds ratio for the consumption of PIM-CCVAE. It is also emphasized that the presence of neurological symptoms proved to be a protective factor for this outcome. CONCLUSION Given the clinical severity and imminent risk of CCVAE in the researched group, preventive measures should be instituted to minimize health problems related to medication in the public network.
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12
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Booker SQ, Content VG. Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis. J Clin Nurs 2020; 29:2675-2690. [PMID: 32301200 DOI: 10.1111/jocn.15292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 01/01/2023]
Abstract
AIM AND OBJECTIVES To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use. BACKGROUND African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. DESIGN A descriptive, secondary mixed-methods analysis. METHODS A convenience sample of 110 African American adults (50-94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis. RESULTS Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension. CONCLUSIONS There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. RELEVANCE TO CLINICAL PRACTICE Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, The University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence (PRICE), The University of Florida, Gainesville, FL, USA
| | - Virginia G Content
- Pain Research and Intervention Center of Excellence (PRICE), The University of Florida, Gainesville, FL, USA
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13
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Stanley CE, Mauss AS, Borst A, Cooper RL. The Effects of Chloride Flux on Drosophila Heart Rate. Methods Protoc 2019; 2:mps2030073. [PMID: 31443492 PMCID: PMC6789470 DOI: 10.3390/mps2030073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022] Open
Abstract
Approaches are sought after to regulate ionotropic and chronotropic properties of the mammalian heart. Electrodes are commonly used for rapidly exciting cardiac tissue and resetting abnormal pacing. With the advent of optogenetics and the use of tissue-specific expression of light-activated channels, cardiac cells cannot only be excited but also inhibited with ion-selective conductance. As a proof of concept for the ability to slow down cardiac pacing, anion-conducting channelrhodopsins (GtACR1/2) and the anion pump halorhodopsin (eNpHR) were expressed in hearts of larval Drosophila and activated by light. Unlike body wall muscles in most animals, the equilibrium potential for Cl− is more positive as compared to the resting membrane potential in larval Drosophila. As a consequence, upon activating the two forms of GtACR1 and 2 with low light intensity the heart rate increased, likely due to depolarization and opening of voltage-gated Ca2+ channels. However, with very intense light activation the heart rate ceases, which may be due to Cl– shunting to the reversal potential for chloride. Activating eNpHR hyperpolarizes body wall and cardiac muscle in larval Drosophila and rapidly decreases heart rate. The decrease in heart rate is related to light intensity. Intense light activation of eNpHR stops the heart from beating, whereas lower intensities slowed the rate. Even with upregulation of the heart rate with serotonin, the pacing of the heart was slowed with light. Thus, regulation of the heart rate in Drosophila can be accomplished by activating anion-conducting channelrhodopsins using light. These approaches are demonstrated in a genetically amenable insect model.
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Affiliation(s)
- Catherine E Stanley
- Department of Biology, Center for Muscle Biology. University of Kentucky, Lexington, KY 40506-0225, USA
| | - Alex S Mauss
- Max Planck Institute of Neurobiology, 82152 Martinsried, Germany
| | - Alexander Borst
- Max Planck Institute of Neurobiology, 82152 Martinsried, Germany
| | - Robin L Cooper
- Department of Biology, Center for Muscle Biology. University of Kentucky, Lexington, KY 40506-0225, USA.
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