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The St Vincent's potentially inappropriate medicines study: development of a disease‐specific consensus list and its evaluation in ambulatory heart failure care
Author(s) -
Bermingham Margaret,
Ryder Mary,
Travers Bronagh,
Edwards Nuala,
Lalor Lorraine,
Kelly Deirdre,
Gallagher Joseph,
O'Hanlon Rory,
McDonald Kenneth,
Ledwidge Mark
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.132
Subject(s) - medicine , interquartile range , hazard ratio , polypharmacy , heart failure , population , confidence interval , ambulatory , clinical endpoint , intensive care medicine , emergency medicine , randomized controlled trial , environmental health
Aims Heart failure ( HF ) patients may be at risk of prescription of potentially inappropriate medicines ( PIMs ) yet no disease‐specific list is available to assess PIM use in this population. A Consensus Potentially Inappropriate Medicines in Heart Failure ( PIMHF ) list was developed, assessed, and compared with an established, general tool in an ambulatory HF population. Methods and results The Consensus PIMHF list was compiled using modified Delphi methodology with a multidisciplinary team. The list consisted of 11 items. The medication profile of 350 patients was assessed. The association of a Consensus PIMHF item use over a median follow‐up period of 1.8 (interquartile range 1.3–2.1) years with the primary endpoint of death, acute hospitalization, or unscheduled outpatient visit was examined. Fifty‐one patients (14.6%) were prescribed ≥1 Consensus PIMHF item. In univariable analysis, patients prescribed ≥1 Consensus PIMHF item were 58% more likely to experience the primary endpoint than those with none [95% confidence interval ( CI ) 1.02–2.45]. When adjusted for age, sex, and HF severity, this difference remained [hazard ratio ( HR ) 1.88, 95% CI 1.16–3.06] and these associations were in contrast to the use of a more general tool ( HR 1.24, 95% CI 0.83–1.84). However, when further adjusted to include co‐morbidity score and polypharmacy, there was no association with outcome using either tool ( HR 1.40, 95% CI 0.83–2.38; HR 1.05, 95% CI 0.69–1.60, respectively). Conclusion The Consensus PIMHF list provides the first HF ‐specific medicines review tool. These results provide some support for more disease‐specific tools with limited lists of PIMs to rationalize medicines management in HF . However, more prospective work on the application of these tools in practice is needed.