Key result
Prescription of ≥1 potentially inappropriate medicine was not associated with death, acute hospitalization, or unscheduled outpatient visits after full adjustment (HR 1.40; 95% CI 0.83-2.38).
Why the study?
Does the prescription of potentially inappropriate medicines (PIMHF items) increase the risk of adverse clinical outcomes in ambulatory heart failure patients?
Cohort (n=350)
Does the prescription of potentially inappropriate medicines (PIMHF items) increase the risk of adverse clinical outcomes in ambulatory heart failure patients?
A newly developed HF-specific potentially inappropriate medicines list identified 14.6% of ambulatory HF patients on such medications, though its association with adverse outcomes was attenuated after adjusting for comorbidities and polypharmacy.
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.
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Bermingham et al. (2014) conducted a cohort in Heart failure (n=350). Prescription of ≥1 Consensus PIMHF item vs. No Consensus PIMHF items was evaluated on Death, acute hospitalization, or unscheduled outpatient visit (HR 1.40, 95% CI 0.83-2.38). Prescription of ≥1 potentially inappropriate medicine was not associated with death, acute hospitalization, or unscheduled outpatient visits after full adjustment (HR 1.40; 95% CI 0.83-2.38).
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