Extended thromboprophylaxis in heart failure patients; the unmet need.

Heart failure (HF) is considered one of a leading cause of cardiovascular morbidity and mortality worldwide. The association between HF and venous thromboembolism (VTE) has been reported in several studies owing to many physiological and thromboembolic risk factors. Thus, the need for extended thromboprophylaxis during the post-discharge period in HF patients has been evaluated. Most guidelines do not recommend extended thromboprophylaxis because of its uncertain benefits and increased risk of bleeding. However, recent evidence in HF patients revealed no increased risk of bleeding with extended thromboprophylaxis, which highlights the importance of identifying ideal candidates who might benefit from extended thromboprophylaxis. Several risk assessment models (RAMs) have been developed to identify patients at a high risk of VTE who would benefit from in-hospital and post-discharge prophylactic anticoagulation therapy based on the risk-benefit principle. However, their accuracy in predicting VTE is questionable, and none have a standardized approach for evaluating the risk of VTE in HF patients. In this review, we provided an overview of the incidence and pathophysiology of VTE in HF patients, a summary of guideline recommendations for VTE prevention, and a summary of studies evaluating the use of extended thromboprophylaxis, with a focus on subgroup or post-hoc analyses of HF patients. We also discussed the need to design an ideal RAM that can identify candidate patients for extended thromboprophylaxis by stratifying the risk of VTE and identifying the key risk factors for bleeding in medically ill patients, including those with HF.

The Prevalence of Prescribing Inappropriate Medications Among Older Adults in Saudi Arabia with Dementia Based on Beers Criteria: A Retrospective Study.

Background: Dementia is a common neurogenerative disease among older adults. Therefore, they are more prone to potentially inappropriate medication (PIM), which is medication that causes more harm rather than protecting the health of an individual. Hence, the American Geriatrics Society (AGS) has recognized the risk of certain medication classes on this population and released PIM according to Beers criteria, which is a helpful guide for clinicians to ensure the safety of medication before it is prescribed. The aim of this study is to assess the prevalence of PIM use among older adults with dementia as a risk factor in comparison to other older adults without dementia. Methods: A retrospective study was conducted in an outpatient setting in a tertiary hospital targeting elderly patients aged 65 years old or over from January 2020 to September 2022. A total of 598 patients were screened, and 270 patients met the inclusion criteria. The eligible patients were then divided into two groups: 168 were in a non-dementia group and 102 were in a dementia group. Results: PIM use was reported in patients with and without dementia. The most inappropriate medication that was prescribed comprised atypical antipsychotics PIM for both patients with and without dementia. However, the prevalence was higher in the dementia group for quetiapine (75% vs 24% respectively), olanzapine (82% vs 17% respectively) or risperidone (92% vs 7%, respectively). Anticholinergics were highly prescribed in older adult without dementia as compared to dementia patient and was statistically significant for solifenacin (96% vs.3.6% respectively) and amitriptyline (88% vs 11% respectively). Conclusion: Among elderly patients in outpatient care settings, the prevalence of PIM use is considered high in dementia patients for antipsychotics, while a higher use of benzodiazepine and anticholinergics was found in non-dementia patients.

Medication self-management capacity among older adults living in low-income housing communities.

BACKGROUND: Medication self-management capacity (MMC) is essential to safe and independent living. There is a need to understand the challenges low-income older adults face during the routine use of medications to promote safe medication use and healthy aging in place. OBJECTIVE: To assess the cognitive and physical deficiencies in MMC and the impact of using pharmaceutical aids/services on MMC among low-income older adults. METHODS: This was a cross-sectional study of 107 older residents of 5 low-income housing buildings in Richmond, VA. The Medication Management Instrument for Deficiencies in the Elderly was used to measure MMC during individual in-person interviews. Participants were asked whether they used any medication aids, including medication lists, organizers, or reminders, or pharmacy services such as specialized medication packaging, medication synchronization, prescription home delivery, or mail order services. Multiple regression modeling was used to assess the relationship between MMC and the use of pharmaceutical aids/services. RESULTS: Eighty-nine percent of participants were African American with a mean (standard deviation [±SD]) age of 68.5 (7.2) years. The mean deficit in MMC was 3 (±2.0). The most challenging skill was naming all the medications (69.2%), followed by stating their indications (46.7%) and knowing how or when all of the medications should be taken (38.3%). Seventy-nine percent used at least 1 pharmaceutical aid/service; using 1 pharmaceutical aid/service was significantly associated with better MMC (P = .0285). Low educational level and health literacy were associated with deficits in MMC (P < .05). CONCLUSION: Many older adults residing in low-income housing had impaired capacity to manage their medications independently. Inadequate medication knowledge affected their cognitive ability to manage medications. Using a pharmaceutical aid/service was associated with better MMC. Greater attention to developing medication self-management skills for older adults with low health literacy and adverse social determinants of health is needed.

Appropriateness of anticoagulation level in older adult patients on Warfarin: A multicenter retrospective study.

Warfarin is favored over newer direct oral anticoagulants (DOACs) for many older adults. However, its use necessitates rigorous monitoring due to the fine line between toxic and therapeutic doses. Few studies have evaluated the anticoagulation quality of warfarin among elderly patients in Saudi Arabia. This study aimed to assess and identify factors affecting the anticoagulation quality of warfarin using the time in the therapeutic range (TTR) among older adults attending two hospitals in Saudi Arabia. Additionally, we aimed to evaluate differences in the anticoagulation quality of warfarin when managed by pharmacists or physicians. This cross-sectional study was conducted at King Abdullah bin Abdulaziz University Hospital (KAAUH) and King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. After calculating the TTR of each patient, the anticoagulation control level was determined using these values: a) good control: >70 %; b) intermediate control: 50-70 %; c) poor control: <50 %. A total of 132 patients prescribed warfarin therapy for different indications were included. Most patients (45.5 %) had poor control with TTRs < 50 %, while 18.2 % had intermediate control, and 36.4 % had good control. Our exploratory findings suggest that having three or more comorbidities was a significant factor associated with a poor TTR [odds ratio (OR) = 3.36; (95 % confidence interval 1.28-8.81); P = 0.014]. Thus, the anticoagulation quality of warfarin among older adult patients was poor in two Saudi Arabian tertiary hospitals, and the number of comorbidities was a potentially poor TTR predictor.

The Effects of Social Media Addiction, Psychological Distress, and Loneliness on Suicide Ideations and Attempts Among Healthcare Professionals in Saudi Arabia.

INTRODUCTION: Recently, there has been an alarming increase in psychological distress in many populations. One of the reasons can be attributed to the rapid development of technology and social media, which could adversely affect the mental health of individuals, including those working in healthcare. This study aimed to assess the influence of social media addiction, psychological distress, and loneliness on suicidal ideations and suicide attempts among healthcare students and professionals in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study collected data from healthcare students and professionals using a five-part questionnaire: (i) demographics, (ii) the Bergen Social Media Addiction Scale (BSMAS), (iii) the Kessler Psychological Distress Scale (K10), (iv) the De Jong Gierveld Loneliness Scale (DGLS), and (v) suicide ideation and attempts scale. RESULTS: There were 800 participants from 33 cities who completed the questionnaire. A total of 31.37% reported lifelong thoughts of suicide, regardless of whether they would actually go through with it (S1), 18.38% had suicidal thoughts within the last 12 months (S2), and 11% had attempted suicide (S3). Of those who attempted suicide, 79 (89.77%) reported seeking help. Multiple logistic regression showed that lifetime suicidal thoughts were predicted by psychological distress, emotional loneliness (EL), social loneliness (SL), and age. Having had suicidal thoughts within the prior 12 months was predicted by psychological distress, SL, and age. Suicidal attempts were predicted by psychological distress, EL, age, and social media addiction. CONCLUSIONS: Our findings demonstrated that psychological distress and loneliness are strongly associated with suicidal ideas and suicide attempts. Such results could serve as a warning call that assists healthcare professionals and mental health teams in arranging and planning effective interventions and actions to raise awareness, as well as reduce the levels of psychological distress and loneliness that could lead to grave consequences.

Measuring Medication Self-Management Capacity: A Scoping Review of Available Instruments.

BACKGROUND: Managing a medication regimen is a complex self-care activity that requires a high level of integration and coordination between cognitive and physical skills. This scoping review aims to identify available instruments designed to assess an adult individual's ability to manage a medication regimen independently and to identify reliable and valid tools to be used in clinical practice and research. METHODS: Five databases (PubMed/MEDLINE, CINAHL Complete, PsycINFO, Embase, and International Pharmaceutical Abstracts) were searched to identify articles reporting the development of an instrument to assess medication self-management capacity in adults. The process included a broad initial search of the databases, followed by screening of titles and abstracts, and full review of relevant articles. For each instrument identified, characteristics, including validity and reliability assessments, were summarized. RESULTS: Sixteen papers were identified that reviewed or described the development and/or validation of 26 instruments designed to assess medication self-management capacity. Most instruments were designed to identify cognitive and physical barriers to successful medication management, but there was inconsistency across instruments in the specific skills assessed and the assessment method used. Most instruments were validated by testing at least one related construct, such as cognitive function, activities of daily living or instrumental activities of daily living performance, or medication adherence. CONCLUSION: Development of standardized instruments to quantify medication self-management capacity is still growing. The choice of instrument for use in a specific clinical or research setting will depend on the purpose for making the assessment and the population that it will be applied to. Results of this review can assist in selecting an appropriate instrument or guiding the development of new instruments for assessment of medication self-management capacity for specific clinical or research purposes.

Person-Centered Care: Evaluation of a Resident-Directed Medication Administration Program.

Objective The resident-directed medication administration program (RDMA) is a personalized medication approach designed to improve the medication administration process in long-term care facilities (LTCFs). This evaluation aimed to document staff experience with the RDMA program compared with staff working in facilities using a facility-directed medication administration program (FDMA). Design This descriptive program evaluation invited staff members to share their experiences with the medication administration process through an anonymous survey. Setting Three LTCFs using a RDMA program and three LTCFs using a FDMA program operated by a nonprofit health system in the mid-Atlantic region. Participants All medication administration staff working in six LTCFs were invited to participate (n = 28), and 22 evaluable surveys were returned. Pharmacists (n = 2), providers (n = 5), and nursing staff (n = 4) working in the RDMA facilities described their experiences with the RDMA program. Primary Outcome Measures Time spent administering medications, satisfaction with the medication administration process, medication administration error rate. Results Most staff members were satisfied with the program and would recommend it for other facilities. Medication administration staff at RDMA facilities reported that they were able to spend more time engaged with residents and less time administering medications. There were fewer medication administration errors in RDMA facilities. Conclusion Implementation of a personalized approach to medication administration is feasible and can promote a positive staff experience with the medication administration process with fewer medication errors.