POTENTIALLY INAPPROPRIATE PRESCRIBING IN GERIATRIC PATIENTS HOSPITALIZED WITH CARDIOVASCULAR DISORDERS USING START/STOPP CRITERIA AT UNIVERSITY OF GONDAR TEACHING HOSPITAL, NORTHWEST, ETHIOPIA. CROSSSECTIONAL STUDY.

Abstract

Background: There was paucity of data on the magnitude of potentially inappropriate prescriptions (PIPs) among Ethiopian elderly cardiovascular patients.

Objective: The aim of this study was to assess inappropriate prescription (IP) and associated factors in elderly patients with cardiovascular medical conditions using START/STOPP screening criteria.

Methods: A hospital based cross-sectional study was conducted at University of Gondar hospital from 1/December/2016- 30/may/ 2017. All Elderly patients hospitalized with cardiovascular disorders during the study period were our subjects. Patients’ medications were evaluated with START/STOPP screening criteria on daily basis until discharge. Multivariable logistic regression was applied to identify factors associated with inappropriate medications. One Way Analysis Of Variance (ANOVA) was carried out to test significant differences on the number of PIPs per individual diagnosis. The level of significance of the study was kept at p-value of 0.05 with 95% confidence interval.

Results: Two hundred thirty-nine patients who fulfilled the inclusion criteria, were considered for the analysis. The mean age of the respondents was 72.52 ±7.7. More than one-third of patients were diagnosed with heart failure 88(36.82%). PIPs were identified in 147 patients, which gives to the prevalence of PIPs 61.5 % in the set-up. The prevalence of one PIPs was 183(57%). The rate of two IPs was 126(39.25%) whereas, three IPs were observed 12(3.75%) times, leads to a total PIP of three hundred twenty one (321) PIPs. One way ANOVA test showed significant differences on the mean number of IPs per individual diagnosis (f=5.718, p<0.001). Angiotensin Converting Enzyme Inhibitors (ACEIs) were the most commonly miss-prescribed drugs (16.19%). Hospital stay, AOR: 1.086[1.016-1.160], number of drugs at discharge, AOR: 1.924 [1.217-3.041] and the presence of comorbidities, AOR: 3.127[1.706-5.733] increased the likelihood of PIP.

Conclusion: More than half of older cardiovascular patients encountered potentially inappropriate prescription. ACEIs were the most commonly miss-prescribed medications. Longer hospital stay, presence of comorbidities and prescription of large number of drugs at discharge date have been correlated with the occurrence of inappropriate medication. It is essential to evaluate patients’ medications during hospital stay using the STOPP and START tool to reduce PIPs.

Keywords: Potentially Inappropriate Prescribing, Cardiovascular disease, START/STOPP criteria