Assessment of Potentially Inappropriate Medication Use in Korean Elderly Patients with Chronic Heart Failure

국내 노인 심부전 환자에서의 잠재적으로 부적절한 약물사용 현황에 대한 연구

  • Received : 2014.03.25
  • Accepted : 2014.05.12
  • Published : 2014.06.30

Abstract

Purpose: The purpose of the present study was to assess the incidence of the potentially inappropriate medication (PIM) use in Korean elderly patients with heart failure, and to evaluate factors that influence PIM use. Method: Korean National Health Insurance claims database between January 2009 and December 2009 was used. Using 2012 updated Beers criteria, PIM use in heart failure patients aged 65 years or older was examined. Result: The incidence of PIM use in elderly heart failure patients was higher than in overall elderly patients. Among the 12,759 elderly patients with heart failure, 46.2% of study subjects were prescribed PIM(s) at least once. The number of PIM per 10 medications that patients received per patient was 1.53. The most commonly used PIMs in elderly heart failure patients were benzodiazepines (30.9%), non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors (16.3%), digoxin (9.9%), and spironolactone (9.0%). Women (odds ratio, 1.20; 95% CI, 1.17-1.24), medical aid (odds ratio, 1.11; 95% CI, 1.08-1.13), and long-term facilities (odds ratio, 2.69; 95% CI, 2.44-2.96) were revealed to be important factors associated with PIM use. In addition, patient's age also seems to influence PIM use. Conclusion: Elderly heart failure patients are at a greater risk for adverse drug events attributed by inappropriate medication use. Efforts to increase awareness of PIM use in elderly heart failure patients are needed. In addition, various comprehensive strategies and policies to identify and prevent PIM use should be established nationwide.

Keywords

References

  1. Statistics Korea. Elderly statistics 2012. Available at http:// kostat.go.kr. (Accessed on Dec 18, 2012).
  2. Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38(8): 843-53. https://doi.org/10.1016/S0531-5565(03)00133-5
  3. Gallagher P, Barry P, O'Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther 2007; 32(2): 113-21. https://doi.org/10.1111/j.1365-2710.2007.00793.x
  4. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007; 5(4): 345-51. https://doi.org/10.1016/j.amjopharm.2007.12.002
  5. Hamilton HJ, Gallgher PF, O'Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatrics 2009; 9(5).
  6. Opondo D, Eslami S, Visscher S, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: A systematic review. PLoS One 2012; 7(8): e43617. https://doi.org/10.1371/journal.pone.0043617
  7. Stockl KM, Le L, Zhang S, et al. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care 2010; 16(1): e1-10.
  8. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American geriatrics society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012; 60(4): 616-31. https://doi.org/10.1111/j.1532-5415.2012.03923.x
  9. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: Findings from the. 1996 medical expenditure panel survey. JAMA 2001; 286(22): 2823-9. https://doi.org/10.1001/jama.286.22.2823
  10. McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: A national consensus panel. CMAJ 1997; 156(3): 385-91.
  11. Gallagher P, Ryan C, Byrne S, et al. STOPP (screening tool of older person's prescriptions) and START (screening tool to alert doctors to right treatment). consensus validation. Int J Clin Pharmacol Ther 2008; 46(2): 72-83. https://doi.org/10.5414/CPP46072
  12. Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: The PRISCUS list. Dtsch Arztebl Int 2010; 107(31-32): 543-51.
  13. Rognstad S, Brekke M, Fetveit Al, et al. The Norwegian general practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified delphi study. Scand J Prim Health Care 2009; 27(3): 153-9. https://doi.org/10.1080/02813430902992215
  14. Ministry of Food and Drug Safety. Handbook of appropriate medication use for elderly 2009.
  15. Oh JM. Drug use pattern and evaluation for appropriateness in geriatric patients. Ministry of food and drug safety 2004.
  16. Fialova D, Topinkova E, Gambassi G, et al. AdHOC Project Research Group. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005; 293(11): 1348-58. https://doi.org/10.1001/jama.293.11.1348
  17. Nam JS, Shin WG, Oh JM. Pattern of medications usage and potentially inappropriate medication usage among Korean ambulatory elderly patients based on an explicit criterion. Kor J Clin Phar 2005; 15(2): 149-59.
  18. Yoo BW. Pattern of medication usage and study of Potentially Inappropriate medication usage among elderly patients based on beer's criteria. D.R. Thesis for medical science Soonchunhyang University. 2007.
  19. O'Sullivan DP, O'Mahony D, Parsons C, et al. A prevalence study of potentially inappropriate prescribing in irish longterm care residents. Drugs Aging 2013; 30(1): 39-49. https://doi.org/10.1007/s40266-012-0039-7
  20. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke Statistics?2013 update: A report from the american heart association. Circulation 2013; 127(1): e6-e245. https://doi.org/10.1161/CIR.0b013e31828124ad
  21. Lindenfeld J, Albert NM, Boehmer JP, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail 2010; 16(6): e1-194. https://doi.org/10.1016/j.cardfail.2010.04.004
  22. Rothberg MB, Pekow PS, Liu F, et al. Potentially inappropriate medication use in hospitalized elders J Hosp Med 2008; 3(2): 91-102. https://doi.org/10.1002/jhm.290
  23. Akazawa M, Imai H, Igarashi A, et al. Potentially inappropriate medication use in elderly Japanese patients. Am J Geriatr Pharmacother 2010; 8(2): 146-60. https://doi.org/10.1016/j.amjopharm.2010.03.005
  24. Statistics Korea. The Korean standard classification of diseases and causes of death. 2012. Available at http:// kostat.go.kr/kssc/main/MainAction.do?method=sub&catgrp =kssc&catid1=kssc03. (Accessed on Jan 1, 2013).
  25. Chun YS, Suh YW, Lee ES, et al. Medications causing emergency department visits due to adverse drug reactions in Korean geriatric patients. J Kor Soc Health-Syst Pharm 2012; 29(3): 271-80.
  26. Kim Y, Jung S. Benzodiazepine prescription patterns for the elderly patients at ambulatory care in Korea. JPERM 2008; 1: 60-7.
  27. Antman EM, Bennett JS, Daugherty A, et al. Use of nonsteroidal antiinflammatory drugs: An Update for Clinicians: A scientific statement from the American heart association. Circulation 2007; 115: 1634-42. https://doi.org/10.1161/CIRCULATIONAHA.106.181424
  28. The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336(8): 525-33. https://doi.org/10.1056/NEJM199702203360801
  29. Rathore SS, Curtis JP, Wang Y, et al. Association of serum digoxin concentration and outcomes in patients with heart failure. JAMA 2003; 289(7): 871-8. https://doi.org/10.1001/jama.289.7.871
  30. The Korean Society of cardiology. The manual of heart failure. 2007. Available at http://www.khfs.or.kr/pdf/ebook.pdf. (Accessed on May 13, 2013).
  31. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the American college of cardiology foundation/American heart association task force on practice guidelines: Developed in collaboration with the international society for heart and lung transplantation. Circulation 2009; 119(14): 1977-2016. https://doi.org/10.1161/CIRCULATIONAHA.109.192064
  32. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341(10): 709-17. https://doi.org/10.1056/NEJM199909023411001
  33. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med 2004; 351(6): 543-51. https://doi.org/10.1056/NEJMoa040135
  34. Wiese BS. Geriatric depression: The use of antidepressants in the elderly. BCMJ 2011; 53(7): 341-7.
  35. Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ 2006; 332: 455-9. https://doi.org/10.1136/bmj.38740.439664.DE
  36. Doraiswamy PM, Husalin MM. Anticholinergic drugs and elderly people: a no brainer? Lancet Neurology 2006; 5(5): 379-80. https://doi.org/10.1016/S1474-4422(06)70421-5
  37. Packer M, Carver JR, Rodeheffer RJ, et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE study research group. N Engl J Med 1991; 325(21).
  38. Lacy CF, Armstrong LL, Goldman MP, et al. Drug information handbook, 19th Ed. Ohio: Lexi-Comp, 2010; 1235-1237, 1388-1390.
  39. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007; 356(24): 2457-71. https://doi.org/10.1056/NEJMoa072761