PMID- 36620233 OWN - NLM STAT- MEDLINE DCOM- 20230110 LR - 20230126 IS - 2296-2565 (Electronic) IS - 2296-2565 (Linking) VI - 10 DP - 2022 TI - Evaluation of potentially inappropriate medication in older patients with cardiovascular diseases-STOPP/START-based study. PG - 1023171 LID - 10.3389/fpubh.2022.1023171 [doi] LID - 1023171 AB - OBJECTIVE: This study aims to evaluate the use of STOPP/START criteria in the identification of Potentially inappropriate medication and potential prescribing omissions in older patients with cardiovascular diseases in Bulgaria. Excessive morbidity and mortality has been linked to drug-related problems and increased use of healthcare services and is an understudied problem for Bulgaria. MATERIALS AND METHODS: A prospective, questionnaire-based study was conducted among 543 older patients across 25 pharmacies in Bulgaria. Socio-demographic characteristic, disease profile, symptoms, and medication data were collected. The questionnaire was developed for the purposes of the EUROAGEISM project. Out of all 543 patients, only those with documented cardio-vascular diseases were extracted and the medication profile per patient was evaluated for Potentially inappropriate medication (PIMs) and potentially prescribing omissions (PPOs) using STOPP/START criteria version 2. In addition, several risks for potentially inappropriate prescribing (PIPs), PPOs and PIMs were calculated with the focus being on the Odds and Risks to develop a PIP. RESULTS: Four hundred and twenty eight from 531 patients with known therapy for cardiovascular diseases (CVDs) were included in the analysis of PIP (40.52% aged 65-69 years, 61.88% female, 64% had up to 6 comorbidities, and 21.72% presenting with polypharmacy). A total of 71 PIMs in 64 patients with polypharmacy were identified during applying STOPP criteria. 56% of patients taking above five medicines daily had PIMs. The majority of PIMs (31%) were related to CVDs treatment, followed by PIMs in the treatment of endocrine diseases (22.54%), duplication of medicines (8.46%) and prolonged treatment with benzodiazepines (8.46%). Forty four PPOs were identified with START criteria. 22.72% were related to lack of proton pump inhibitors (PPI) in the presence of gastroesophageal disorders, and the same percentage was for lack of Calcium-vitamin D supplementation in osteoporosis. Applying the methodology of risks calculation the sample risk for PPO was 2.1% and for PIM 3.4%. At sample level the relative risk for PPO was 62% out of the risk for PIM and at population level varied between 42.8 and 89.8% and it is statistically significant. The number needed to treat for the event to happen is 77.5, meaning that at every 78 prescriptions there is a chance to appear PIP. CONCLUSION: Application of methodologies for detection of potentially inappropriate prescribing is not part of routine clinical practice in Bulgaria. Our study demonstrates a high percentage of potentially inappropriate medication among older patients with polypharmacy. Along with the aging population in Bulgaria, economic burden of polypharmacy and the prevalence of cardiovascular diseases, it is especially important to address potentially inappropriate medication use in cardiovascular patients. There is a considerable necessity for implementation of measures for early detection of potentially inappropriate medication and potentially prescribing omission as a part of de-prescribing strategies in older patients. CI - Copyright (c) 2022 Krustev, Milushewa, Tachkov, Mitov and Petrova. FAU - Krustev, Tzvetan AU - Krustev T AD - Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria. FAU - Milushewa, Petya AU - Milushewa P AD - Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria. FAU - Tachkov, Konstantin AU - Tachkov K AD - Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria. FAU - Mitov, Konstantin AU - Mitov K AD - Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria. FAU - Petrova, Guenka AU - Petrova G AD - Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20221222 PL - Switzerland TA - Front Public Health JT - Frontiers in public health JID - 101616579 RN - 1406-16-2 (Vitamin D) SB - IM MH - Humans MH - Female MH - Aged MH - Male MH - *Potentially Inappropriate Medication List MH - *Cardiovascular Diseases/drug therapy/epidemiology MH - Prospective Studies MH - Inappropriate Prescribing MH - Vitamin D PMC - PMC9813954 OTO - NOTNLM OT - STOPP/START criteria OT - cardiovascular diseases OT - elderly patients OT - inappropriate prescribing OT - older patients OT - polypharmacy COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/01/10 06:00 MHDA- 2023/01/11 06:00 PMCR- 2022/12/22 CRDT- 2023/01/09 04:07 PHST- 2022/08/19 00:00 [received] PHST- 2022/12/06 00:00 [accepted] PHST- 2023/01/09 04:07 [entrez] PHST- 2023/01/10 06:00 [pubmed] PHST- 2023/01/11 06:00 [medline] PHST- 2022/12/22 00:00 [pmc-release] AID - 10.3389/fpubh.2022.1023171 [doi] PST - epublish SO - Front Public Health. 2022 Dec 22;10:1023171. doi: 10.3389/fpubh.2022.1023171. eCollection 2022.