Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population.

Background: Aspirin is commonly used for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) but may cause more harm than benefit. This study aimed to assess the percentage of patients who were inappropriately prescribed aspirin in the veteran patient population and to assess safety outcomes associated with inappropriate aspirin use. Methods: Retrospective chart reviews were conducted on up to 200 patients with active prescriptions for 81-mg aspirin tablets filled between October 1, 2019, and September 30, 2021, at the Captain James A. Lovell Federal Health Care Center in Illinois. The primary endpoint was the percentage of patients inappropriately on aspirin therapy and whether these patients were being followed by a clinical pharmacy practitioner. Each patient record was reviewed to determine the appropriateness of aspirin therapy by assessing the indication for use. Safety data were collected for patients who were deemed to be using aspirin inappropriately, including documentation of any major or minor bleeding events. Results: A total of 105 patients were included in this study. For the primary endpoint, 31 patients (30%) had a possible ASCVD risk and were taking aspirin for primary prevention, while 21 patients (20%) had no ASCVD and were taking aspirin for primary prevention. For the secondary endpoint, 25 patients were aged > 70 years, 15 patients were concurrently taking medications that might increase bleeding risk, and 11 patients had chronic kidney disease. Looking at the entire study patient population, for the safety endpoint, 6 patients (6%) experienced a major bleeding event while on aspirin, and 46 (44%) experienced a minor bleeding event while on aspirin. Conclusions: Common factors seen in this study to warrant deprescribing aspirin for primary prevention included individuals aged > 70 years, concurrent use of medications that increase bleeding risk, and patients with chronic kidney disease. By assessing ASCVD and bleeding risks and having a risk/benefit discussion with patients and prescribers, aspirin used for primary prevention can be appropriately deprescribed when the risks of bleeding outweigh the benefits.

Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures.

Antibiotic prophylaxis (AP) in surgical procedures is commonly used to prevent infections that may occur after operations. There are multiple factors that can contribute to increased risk of postsurgical complications that include prolonged hospitalization, reoperation, and readmissions. One of the strategies of decreasing the risk of bacterial contamination and developing infections is preprocedural antibiotic administration. When selecting an appropriate antibiotic, it is important to take into account surgery type and patient's characteristics which would also impact timing of administration and prophylaxis duration. Although surgical AP is significant for avoiding bacterial complications, it is also associated with some drawbacks such as increased antibiotic resistance and development of adverse reactions. Therefore, it is important to assess risks and benefits and select the most appropriate antibiotic regimen before initiating AP.

Chronic Heart Failure: A Pharmacologic Review.

Chronic heart failure affects over 6 million Americans and is the main reason that people older than 65 years get admitted to the hospital (Centers for Disease Control and Prevention, 2020). Management of heart failure requires interdisciplinary efforts involving primary care physicians, cardiologists, nurses, and pharmacists among other providers. Nurses can play a key role in identifying patients at risk for heart failure exacerbation and are often at the front lines providing education regarding medication adherence. This article summarizes the medications used in chronic heart failure and describes common side effects, dosing considerations, and counseling points that are essential for appropriate management.

Acute Decompensated Heart Failure: A Pharmacologic Review.

Chronic heart failure (CHF) is a growing disease in the United States. Exacerbations of CHF can lead to acute decompensated heart failure (ADHF) and hospitalizations. Nurses play a key role in the treatment of ADHF as they administer medications, monitor patients' response to therapy, and can prompt providers to alter therapy if therapeutic outcomes are not being achieved. Nurses also play a vital role in discharge education for patients who are hospitalized for ADHF, as they can counsel patients on ways to reduce further hospitalizations. It is important for nurses to understand and recognize symptoms of ADHF, pharmacologic treatments for ADHF, and common etiologies of ADHF to help improve patient outcomes.

Evaluating a Veterans Affairs Home-Based Primary Care Population for Patients at High Risk of Osteoporosis.

A retrospective chart review of patients in a home-based primary care program suggests that patients who are at high risk for osteoporosis may not be receiving adequate dual-energy X-ray absorptiometry screening.