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Evaluation of the Potentially Inappropriate Cardiovascular Medication Prescription in Elderly: A Nationwide Study in Turkey - PubMed

Evaluation of the Potentially Inappropriate Cardiovascular Medication Prescription in Elderly: A Nationwide Study in Turkey

Mehmet Tevfik Kitapçı et al. Anatol J Cardiol. 2023 Jun.

Abstract

Background: Elderly comprises a specific group due to possible alterations in the effects of drugs and comorbidities. We aimed to identify for the first time the characteristics and rates regarding the inappropriate prescriptions of cardiovascular system medications in the geriatric age group in Turkey.

Methods: Cardiovascular system medications prescribed electronically by family physicians to patients aged 65 and over, in the years 2015 and 2016, were obtained through Prescription Information System administered by the Ministry of Health. Evaluation of potentially inappropriate prescriptions was done according to the 'Beers Criteria 2015 update.' Prescription rates for each group were evaluated under sub-breakdowns for the specialty of family physicians, gender, age groups, and 'Nomenclature of Territorial Units for Statistics' regions.

Results: Approximately 65 million prescriptions were evaluated. The rate of potentially inappropriate cardiovascular medication prescribing was 0.33%. This raised to 11.56% when 'drugs to be used with caution' were included. It was observed that potentially inappropriate drugs have been prescribed more by specialist family physicians. The most frequently prescribed potentially inappropriate drugs were doxazosin in the diagnosis of hypertension and methyldopa regardless of indication. Diclofenac-warfarin was the most commonly prescribed concomitant drug use in the potentially clinically important drug-drug interactions group. The rate of potentially inappropriate drug prescribing was higher in males and in aged 80 years and older.

Conclusions: This pharmacoepidemiological study draws attention to potentially inappropriate cardiovascular system drugs prescribed in primary care settings to the elderly. The rate of potentially inappropriate cardiovascular system drug prescribed was found to be very low in Turkey.

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Figures

Figure 1.
Figure 1.

Percent distribution of population, total prescriptions, and total potentially inappropriate medication (TPIM) use by NUTS (Nomenclature of Territorial Units for Statistics) regions (TR1 Istanbul, TR2 West Marmara, TR3 Aegean, TR4 East Marmara, TR5 West Anatolia, TR6 Mediterranean, TR7 Central Anatolia, TR8 West Black Sea, TR9 East Black Sea, TRA Northeast Anatolia, TRB Middle East Anatolia, TRC Southeast Anatolia). (*P <.001, different from “Total Prescriptions” group, Chi-square).

Figure 2.
Figure 2.

Distribution of the total number of prescriptions containing total potentially inappropriate medication (TPIM) by subgroups when evaluated together with the drugs to be used with caution as a percentage. (PIM: Potentially Inappropriate Medication Use by organ-system, therapeutic category; Disease–Drug: Potentially Inappropriate Medication Use Due to Drug–Disease or Drug–Syndrome Interactions; Drug–Drug: Potentially Clinically Important Drug–Drug Interactions That Should Be Avoided).

Figure 3.
Figure 3.

Distribution of the total number of prescriptions containing total potentially inappropriate medication (TPIM) by subgroups as a percentage. (PIM: Potentially Inappropriate Medication Use by organ-system, therapeutic category; Disease–Drug: Potentially Inappropriate Medication Use Due to Drug–Disease or Drug–Syndrome Interactions; Drug–Drug: Potentially Clinically Important Drug–Drug Interactions That Should Be Avoided).

Figure 4.
Figure 4.

(A) Prescription rates written by specialist and practitioner family physicians are shown in the figure (*P <.001 different from “Total Prescription” group, **P <.001 different from “Distribution of Family Physicians” group, Chi-square). The distribution of family physicians bar is showing the percentages of practitioners and specialists among the total family physician population. (B) Prescription rates for male and female patients aged 65 and over are shown in the figure (*P <.001 different from “Total Prescriptions” group, **P <.001 different from “Population” group, Chi-square). Population bar is showing the percentages of male and female individuals among the whole geriatric population.

Figure 5.
Figure 5.

Prescription rates according to age groups are shown in the figure. (*P <.001 different from “Total Prescriptions” group, **P <.001 different from “Population” group, Chi-square).

Figure 6.
Figure 6.

(A) Percent distribution of methyldopa, reserpine, and nifedipine (immediate release) prescribed within the Potentially Inappropriate Medication (PIM) group; (B) Percent distribution of doxazosin and terazosin prescribed in hypertension within the “Drug–Disease” group; (C) Percent distribution of diltiazem, diclofenac, verapamil, and ketoprofen prescribed in heart failure within the “Drug–Disease” group (the most frequently prescribed 4 drugs are included in the figure) (D) Percent distribution of drugs most frequently prescribed within the “Drug–Drug” Group.

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