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Article Dans Une Revue International Journal of Clinical Pharmacy Année : 2022

Iatrogeny in the elderly: assessment of pharmaceutical interventions in a cardiology department


Background and Objective: The aging of the population is associated with polymedication and therefore a significant likelihood of Potentially inappropriate drug Prescriptions (PIPs) in the elderly. PIPs are associated with a risk of adverse effects and increased: morbidity, use of care, and mortality. Many PIPs are related to cardiovascular care. Since 2020, clinical pharmacy activities have been developed in the cardiology department and pay particular attention to good prescribing practices (GPP) in the elderly subject. The objective of this work is to evaluate pharmaceutical interventions (PI) in the cardiology department with elderly subjects. Design: Retrospective analysis of PIs performed in cardiology over a 1-year period (November 2020 to 2021) in patients over 75 years old. The PIs were extracted using the ACT IP® software of the SFPC (French Society of Clinical Pharmacy). Analysis of PIs with regard to recommendations on GPP in the elderly and categorization of these according to 4 groups: in connection with an PIP; overuse (prescribing without a justified indication), underuse (absence of prescribing for a justified indication), in connection with cardiovascular care. Results: In total, over the period, 1504 PIs were performed in the department, of which 790 (52.2%) concerned patients over 75 years of age. 26.7% of PIs resulted from non-optimal prescribing: 10.2% concerned PIPs, 10.9% underuse and 5.6% overuse. In addition, 35.3% of PIs were related to cardiovascular care, of which 17.3% also concerned sub-optimal prescribing in the elderly. The PIs combining non-optimal prescribing and cardiovascular care mainly concerned the discontinuation of central antihypertensive drugs (18.8%), hypoglycemic sulfonamides (27.1%) and the re-evaluation of statins (18.7%). The PIs issued for non-optimal prescribing not related to cardiovascular care were mainly for the re-evaluation of long half-life benzodiazepines (10%). For underuse, the PIs recommended vitamin D and calcium supplementation (28.2%). Finally, the majority of overuse concerned proton pump inhibitors (17.2%) and hypouricemics (5.5%). The acceptance rate for all PIs was 96.6%. Conclusion: Many of the PIs concern PIPs and therapeutic optimization in the elderly. Also, some PIPs are treatments indicated in cardiovascular pathologies, thus allowing an optimization of the cardiovascular care of patients. The high acceptance rate of PIs reflects the interest of prescribers in this issue and the importance of a pharmaceutical presence in the care services. A detection of PIPS during the drug reconciliation at the entrance by the pharmacyst students has been set up in order to continue this time-consuming work. In addition, new prescribers must be briefed about the need to reduce drug-related iatrogeny in the elderly.
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Dates et versions

hal-04031745 , version 1 (16-03-2023)


  • HAL Id : hal-04031745 , version 1


S. Bouras, Aurélie Terrier-Lenglet, M. Belhout, C. Debanne. Iatrogeny in the elderly: assessment of pharmaceutical interventions in a cardiology department: Conference abstracts, 50th ESCP Symposium on Clinical Pharmacy, Polypharmacy and ageing - highly individualized, interprofessional, person-centered care, 19–21 October 2022, Prague, Czech Republic. International Journal of Clinical Pharmacy, 2022, 44 (6), pp.1536-1537 ; PP105. ⟨hal-04031745⟩


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