ICS 2012 Report – Potentially inappropriate medicines in heart failure

by Edel O’Connell – Report on poster presented at the ICS Annual Meeting

An interesting study from a group of researchers based at the Heart Failure Unit of St Vincent’s University Hospital and School of Medicine and Medical Science in UCD looked at inappropriate prescribing of medicines.

Lead author, Dr Margaret Bermingham explained: “We set out to establish the exact prescribing of potentially inappropriate medicines to a group of patients with heart failure and the costs associated with it.”

Potentially inappropriate prescribing (PIM) is common in older people presenting to Irish hospitals with acute illness.

Heart failure (HF) patients frequently have multiple co-morbidities requiring pharmacotherapy. However, a number of frequently prescribed medicines are contraindicated or cautioned for use in heart failure.
The study sought to establish the extent of prescribing of PIM in HF and the costs associated with PIMs in a stable, outpatient HF population.
“We gave questionnaires to the cardiologists involved in the HSE Heart Failure Clinical Care Programme and asked them to rate the 19 medicines that may be appropriate. From their responses we learned they considered 11 of those medicines to be inappropriate and that included non steroidal anti inflammatories, oral corticosteroids and Pergabalin, drugs in diabetics and medicines high salt in content such as Solpadine or soluble Gaviscon for indigestion” explained Dr Bermingham.

“We then looked at the responses in a group of 350 patients in a heart failure programme in St Vincent’s and we found there was a low level of prescribing of those medicines. In total 2.6 per cent of all medicines prescribed were medicines that were in our potentially inappropriate list, and in unadjusted analysis, there did seem to be a higher rate of events in those patients than in patients who were not using any of the inappropriate medicines,” she added.

The medication records of the 350 consecutive patients were reviewed of whom 228 (65.1 per cent) were male.

The mean age of the population was 72 years.

A total of 380 PIM’s were identified in 264 patients (75.4 per cent).

This accounted for 15.1 per cent of all medicines prescribed.

The most frequently occurring PIM was low dose aspirin (56.3 per cent), followed by inhaled beta2-agonists (17.7 per cent) and dihydropyridine calcium channel antagonists in HF patients with ischemic heart disease (7.1 per cent).

Patients prescribed C1 PIM were more likely to have IHD, chronic obstructive pulmonary disease and diabetes and less likely to have atrial fibrillation than those with no PIM.

The total cost of prescribed PIMs was €3,907.45 per month.
The researchers concluded the HF patients remain at risk of being prescribed a PIM despite being cared for in a HF disease management programme. However, more data is required to clarify potential benefits associated with pharmacist HF medicines review.

“The score raises a number of questions, but one of the problems would be a lot of heart failure patients might have diabetes also and a lot of the medicines used to treat peripheral neuropathy in diabetics would be on our list for inappropriate medicines such as pregabalin and so on,” commented Ms Bermingham.