Potentially inappropriate medications with risk of cardiovascular adverse events in the elderly: A systematic review of tools addressing inappropriate prescribing.

WHAT IS KNOWN AND OBJECTIVE: In the last decades, many lists have been developed to screen for inappropriate prescribing. However, information on which potentially inappropriate medications (PIMs) could increase the cardiovascular risk in the elderly is not objectively presented. This review aimed to identify and quantify those PIMs by extracting information from published PIM-lists. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA), a systematic review of PIM-lists was conducted. The search strategy was run in PubMed, MEDLINE and Google Scholar (1991-09/2017). All PIMs described in those lists were extracted and stratified by their potential cardiovascular risk (including major adverse cardiovascular events-MACE). The number of times each PIM was reported on those lists was also assessed. RESULTS AND DISCUSSION: We identified 724 papers, and 24 were retained. From those, a total of 17 PIMs to be avoided by the elderly and 21 drug-disease interactions were retrieved. The reporting of PIMs with risk of cardiovascular adverse events was 15.3%, whereas the reporting of those with MACE risk was 7.2%. PIMs most frequently described were tricyclic antidepressants (TCAs; 12/24), centrally acting antiadrenergic agents (11/24), NSAIDs (7/24), antiarrhythmics (Class I and III; 6/24), peripherally acting antiadrenergic agents (6/24) and antithrombotic agents (5/24). Most frequently described PIMs with MACE risk were NSAIDs (7/24), antiarrhythmics (Class I and III) (7/24), selective calcium channel blockers with vascular effects (6/24) and antipsychotics (4/24). WHAT IS NEW AND CONCLUSION: Data suggest that PIM-lists focus mainly on common adverse events and often poorly describe the potential consequence for MACE occurrence. This systematic review could help healthcare professionals in the identification and deprescribing of these medicines in older patients with high cardiovascular risk during medication review.

Optimising patient safety using pharmaceutical intervention in domiciliary hospitalization.

Introduction The domiciliary hospitalization unit (DHU) is an innovative model of care provision, where hospital care is transferred to the patients' home. However, this shift adds a care transition layer to the process, which may increase the probability of medication errors to occur. Method A pharmacist has been integrated into the DHU team to improve medication use. We developed an observational study documenting his intervention for 6 months. Information about the patient's drug therapy before admission, during hospitalization and after hospital discharge were gathered, enabling comparison of possible discrepancies that may happen during care transitions. The pharmacist evaluated the appropriateness, necessity, effectiveness, and safety of medication and intervened when deemed appropriate. Conclusions Data suggests that a pharmacist involved in the DHU may have a positive impact on medication use. Medication review and reconciliation are examples of pharmaceutical interventions that may lead to increased effectiveness and patient safety.