Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing.
Jo��o Pedro Aguiar, Ana Mafalda Brito, Ana Paula Martins, Hubert G M Leufkens, Filipa Alves da Costa
Author Information
Jo��o Pedro Aguiar: Research Institute for Medicines (iMED.ULisboa), Faculdade de Farm��cia, Universidade de Lisboa, Lisboa, Portugal. ORCID
Ana Mafalda Brito: Centro de Investiga����o Interdisciplinar Egas Moniz (CiiEM), Instituto Universit��rio Egas Moniz, Caparica, Portugal.
Ana Paula Martins: Research Institute for Medicines (iMED.ULisboa), Faculdade de Farm��cia, Universidade de Lisboa, Lisboa, Portugal.
Hubert G M Leufkens: Division of Pharmacoepidemiology and Clinical Pharmacy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
Filipa Alves da Costa: Centro de Investiga����o Interdisciplinar Egas Moniz (CiiEM), Instituto Universit��rio Egas Moniz, Caparica, Portugal. ORCID
WHAT IS KNOWN and OBJECTIVE: In the last decades, many lists have been developed to screen for inappropriate prescribing. However, information on which potentially inappropriate medications (PIMs) could increase the cardiovascular risk in the elderly is not objectively presented. This review aimed to identify and quantify those PIMs by extracting information from published PIM-lists. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), a systematic review of PIM-lists was conducted. The search strategy was run in PubMed, MEDLINE and Google Scholar (1991-09/2017). All PIMs described in those lists were extracted and stratified by their potential cardiovascular risk (including major adverse cardiovascular events-MACE). The number of times each PIM was reported on those lists was also assessed. RESULTS and DISCUSSION: We identified 724 papers, and 24 were retained. From those, a total of 17 PIMs to be avoided by the elderly and 21 drug-disease interactions were retrieved. The reporting of PIMs with risk of cardiovascular adverse events was 15.3%, whereas the reporting of those with MACE risk was 7.2%. PIMs most frequently described were tricyclic antidepressants (TCAs; 12/24), centrally acting antiadrenergic agents (11/24), NSAIDs (7/24), antiarrhythmics (Class I and III; 6/24), peripherally acting antiadrenergic agents (6/24) and antithrombotic agents (5/24). Most frequently described PIMs with MACE risk were NSAIDs (7/24), antiarrhythmics (Class I and III) (7/24), selective calcium channel blockers with vascular effects (6/24) and antipsychotics (4/24). WHAT IS NEW and CONCLUSION: Data suggest that PIM-lists focus mainly on common adverse events and often poorly describe the potential consequence for MACE occurrence. This systematic review could help healthcare professionals in the identification and deprescribing of these medicines in older patients with high cardiovascular risk during medication review.
