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Potentially inappropriate medications use and its association with health-related quality of life among elderly cardiac patients

Quality of Life Research volume 29, pages 2715–2724 (2020)Cite this article

Abstract

Background

Previous studies identified alarming use of potentially inappropriate medications (PIMs) in Pakistani population but its effect on health-related quality of life (HRQoL) is still largely unknown.

Objective

This study aimed to determine the association between PIMs use and HRQoL among elderly cardiac outpatients.

Method

A descriptive, non-experimental, cross-sectional study was carried out from June 2018 to September 2018 in two outpatient departments of tertiary-care hospitals in the Punjab Province of Pakistan. The population under study were patients aged ≥ 65 years with at least one cardiovascular condition taking at ≥ 1 prescribed medication. Patients with PIMs were identified by using Beers criteria. HRQoL was assessed using EuroQoL-5 dimension (EQ-5D) and EuroQoL-visual analogue scale (EQ-VAS). The association of PIMs with HRQoL was analyzed using χ2 tests, independent sample t-test, and one-way ANOVA tests. Multiple linear regression analysis was used to determine how HRQoL varied by PIMs use after adjusting for patient-level covariates.

Results

Of 386 elderly cardiac patients, 260 (67.4%) patients were receiving at least one PIM. Mean EQ-5D scores were significantly lower among patients with PIMs (0.51) compared to patients without PIMs (0.65) (P < 0.001). In multiple linear regression analysis, increasing numbers of PIMs were significantly associated with lower EQ-5D scores [β =  − 0.040 (− 0.075, − 0.005), P < 0.001] and VAS scores [β =  − 1.686 (− 2.916, − 0.456), P < 0.05].

Conclusion

The present study concluded that exposure to PIM was significantly associated with lower HRQoL. This indicates that guidelines recommendations should be followed to improve patient’s quality of life.

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Data availability

The data and materials are available with the corresponding author and can be obtained upon a request.

References

  1. WHO. (2019). Cardiovascular diseases (CVDs). WHO. Retrieved June 21, 2019, from https://www.who.int/cardiovascular_diseases/en/.

  2. Zubair, F., Nawaz, S. K., Nawaz, A., Nangyal, H., Amjad, N., & Khan, M. S. (2018). Prevalence of cardiovascular diseases in Punjab, Pakistan: A cross-sectional study. Journal of Public Health, 26(5), 523–529. https://doi.org/10.1007/s10389-018-0898-4.

    Article  Google Scholar 

  3. World Health Organization. (2014). Global status report on noncommunicable diseases 2014. https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=C605227C1D2CD5792266915257213C82?sequence=1.

  4. Shafi, S. T., & Shafi, T. (2017). A survey of hypertension prevalence, awareness, treatment, and control in health screening camps of rural central Punjab, Pakistan. Journal of Epidemiology and Global Health, 7(2), 135–140. https://doi.org/10.1016/j.jegh.2017.01.001.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jastaniah, N. A., Almaqati, A. S., Alsuraihi, A. K., Abughanim, S. A., & Aseeri, M. (2018). Inappropriate prescribing in elderly inpatients at a university hospital in Saudi Arabia. Drugs: Real World Outcomes. https://doi.org/10.1007/s40801-018-0142-0.

    Article  Google Scholar 

  6. Herrera, A. P., Snipes, S. A., King, D. W., Torres-Vigil, I., Goldberg, D. S., & Wenberg, A. D. (2010). Disparate inclusion of older adults in clinical trials: priorities and opportunities for policy and practice change. American Journal of Public Health, 100(Suppl 1), 105–112. https://doi.org/10.2105/AJPH.2009.162982.

    Article  Google Scholar 

  7. Nelson, E. E., & Guyer, A. E. (2012). Age disparities in heart failure research. JAMA, 1(3), 233–245. https://doi.org/10.1016/j.dcn.2011.01.002.The.

    Article  Google Scholar 

  8. Spinewine, A., Schmader, K. E., Barber, N., Hughes, C., Lapane, K. L., Swine, C., et al. (2007). Appropriate prescribing in elderly people: How well can it be measured and optimised? The Lancet, 370(9582), 173–184. https://doi.org/10.1016/S0140-6736(07)61091-5.

    Article  Google Scholar 

  9. Samuel, M. J. (2015). American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. Journal of American Geriatric Society, 63(11), 2227–2246. https://doi.org/10.1111/jgs.13702.

    Article  Google Scholar 

  10. Bladh, L., Ottosson, E., Karlsson, J., Klintberg, L., & Wallerstedt, S. M. (2011). Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: A randomised controlled trial. BMJ Quality and Safety, 20(9), 738–746. https://doi.org/10.1136/bmjqs.2009.039693.

    Article  PubMed  Google Scholar 

  11. Vaarama, M. (2009). Care-related quality of life in old age. European Journal of Ageing, 6(2), 113–125. https://doi.org/10.1007/s10433-009-0115-y.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kaplan, R. M. (2003). The significance of quality of life in health care. Quality of Life Research , 12(Suppl 1), 3–16. https://www.ncbi.nlm.nih.gov/pubmed/12803306.

  13. Fu, A. Z., Liu, G. G., & Christensen, D. B. (2004). Inappropriate medication use and health outcomes in the elderly. Journal of American Geriatric Society, 52(11), 1934–1939.

    Article  Google Scholar 

  14. Nordin Olsson, I., Runnamo, R., & Engfeldt, P. (2011). Medication quality and quality of life in the elderly, a cohort study. Health and Quality of Life Outcomes, 9(1), 95. https://doi.org/10.1186/1477-7525-9-95.

    Article  PubMed Central  Google Scholar 

  15. Sarwar, M. R., Dar, A. R., Mahar, S. Y., Riaz, T., Danish, U., & Iftikhar, S. (2018). Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: A cross-sectional study in Lahore, Pakistan. Clinical Interventions in Aging, 13, 1485–1495. https://doi.org/10.2147/CIA.S173942.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mazhar, F., Akram, S., Malhi, S. M., & Haider, N. (2018). A prevalence study of potentially inappropriate medications use in hospitalized Pakistani elderly. Aging Clinical and Experimental Research, 30(1), 53–60. https://doi.org/10.1007/s40520-017-0742-7.

    Article  PubMed  Google Scholar 

  17. Finance Division, Government of Pakistan. (2018). Pakistan Economic Survey 2017–2018. Finance Division, Government of Pakistan. www.finance.gov.pk.

  18. Sainsbury, A., Seebass, G., Bansal, A., & Young, J. B. (2005). Reliability of the Barthel Index when used with older people. Age and Ageing, 34(3), 228–232. https://doi.org/10.1093/ageing/afi063.

    Article  PubMed  Google Scholar 

  19. Wade, D. T., & Collin, C. (1988). The Barthel ADL index: A standard measure of physical disability? Disability and Rehabilitation, 10(2), 64–67. https://doi.org/10.3109/09638288809164105.

    CAS  Article  Google Scholar 

  20. Steinman, M. A., Beizer, J. L., DuBeau, C. E., Laird, R. D., Lundebjerg, N. E., & Mulhausen, P. (2015). How to use the American Geriatrics Society 2015 Beers Criteria—A guide for patients, clinicians, health systems, and Payors. Journal of American Geriatric Society, 63(12), e1–e7. https://doi.org/10.1111/jgs.13701.

    Article  Google Scholar 

  21. EQ-5D-3L–EQ-5D. (n.d.). Retrieved June 21, 2019, from https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/.

  22. EuroQoL Group. (1990). EuroQoL*—A new facility for the measurement of health-related quality of life. Health Policy, 16, 199–206.

    Article  Google Scholar 

  23. Mulhern, B., Feng, Y., Shah, K., Janssen, M. F., Herdman, M., van Hout, B., et al. (2018). Comparing the UK EQ-5D-3L and English EQ-5D-5L value sets. Pharmacoeconomics, 36, 699–713. https://doi.org/10.1007/s40273-018-0628-3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Saleem, F., Hons, B. P., Pharm, M. P., Hrm, M. B. A., Azmi, M., Pharm, H. B., et al. (2012). A cross-sectional assessment of health-related quality of life (HRQoL) among hypertensive patients in Pakistan. Health Expectations, 17(3), 388–395. https://doi.org/10.1111/j.1369-7625.2012.00765.x.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Haq, N., Hassali, M. A., Shafie, A. A., Saleem, F., & Aljadhey, H. (2012). A cross sectional assessment of health related quality of life among patients with Hepatitis-B in Pakistan. Health and Quality of Life Outcomes, 10, 1–7. https://doi.org/10.1186/1477-7525-10-91.

    Article  Google Scholar 

  26. Olsson, I. N., Runnamo, R., & Engfeldt, P. (2011). Medication quality and quality of life in the elderly, a cohort study. Health and Quality of Life Outcomes, 9, 1–9.

    Article  Google Scholar 

  27. Holland, R., Lenaghan, E., Harvey, I., Smith, R., Shepstone, L., Lipp, A., et al. (2005). Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. British Medical Journal, 330(7486), 293–295. https://doi.org/10.1136/bmj.38338.674583.AE.

    Article  PubMed  Google Scholar 

  28. Franic, D. M., Pharm, D., Ph, D., & Jiang, J. Z. (2006). Potentially inappropriate drug use and health-related quality of life in the elderly. Pharmacotherapy, 26(6), 768–778.

    Article  Google Scholar 

  29. Shah, K., Joshi, H., Christian, R., Patel, K., & Malhotra, S. (2016). Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India. Journal of Basic and Clinical Pharmacy, 7(4), 110. https://doi.org/10.1103/PhysRevB.91.155436.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Abegaz, T. M., Birru, E. M., & Mekonnen, G. B. (2018). Potentially inappropriate prescribing in Ethiopian geriatric patients hospitalized with cardiovascular disorders using START/STOPP criteria. PLoS ONE, 13(5), 1–14. https://doi.org/10.1371/journal.pone.0195949.

    CAS  Article  Google Scholar 

  31. Luis Martínez-Arroyo, J., Gómez-García, A., & Sauceda-Martínez, D. (2014). Prevalencia de la polifarmacia y la prescripción de medicamentos inapropiados en el adulto mayor hospitalizado por enfermedades cardiovasculares. Gaceta Médica de México, 150(Suppl 1), 29–38.

    Google Scholar 

  32. Al Khaja, K. A. J., Ahmed Isa, H., Veeramuthu, S., & Sequeira, R. P. (2018). Potentially inappropriate prescribing in older adults with hypertension or diabetes mellitus and hypertension in a primary care setting in Bahrain. Medical Principles and Practice, 27(3), 241–249. https://doi.org/10.1159/000488055.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bazargan, M., Smith, J. L., & King, E. O. (2018). Potentially inappropriate medication use among hypertensive older African-American adults. BMC Geriatrics, 18(1), 238. https://doi.org/10.1186/s12877-018-0926-9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Carmen, A., Simoes, R., Lamas, A., & Lucchetti, G. (2017). Inappropriate prescribing in older hospitalized adults : A comparison of medical specialties. Drugs and Pharmacology. https://doi.org/10.1111/jgs.15138.

    Article  Google Scholar 

  35. Sheikh-Taha, M., & Dimassi, H. (2017). Potentially inappropriate home medications among older patients with cardiovascular disease admitted to a cardiology service in USA. BMC Cardiovascular Disorders, 17(1), 189. https://doi.org/10.1186/s12872-017-0623-1.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lai, Y. R., Yang, Y. S., Tsai, M. L., Lu, Y. L., Kornelius, E., Huang, C. N., et al. (2016). Impact of potentially inappropriate medication and continuity of care in a sample of Taiwan elderly patients with diabetes mellitus who have also experienced heart failure. Geriatrics and Gerontology International, 16(10), 1117–1126. https://doi.org/10.1111/ggi.12606.

    Article  PubMed  Google Scholar 

  37. Al Aqqad, S. M., Chen, L. L., Shafie, A. A., Hassali, M. A., & Tangiisuran, B. (2014). The use of potentially inappropriate medications and changes in quality of life among older nursing home residents. Clinical Interventions in Aging, 9, 201–207.

    PubMed  Google Scholar 

  38. Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research, 14(6), 1523–1532. https://doi.org/10.1007/sl1136-004-7713-0.

    Article  PubMed  Google Scholar 

  39. Wallace, E., Smith, S. M., Mcdowell, R., Bennett, K., & Fahey, T. (2016). Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice : A prospective cohort study. Journal of Gerontology Series A Biological Science and Medical Sciences, 72(2), 271–277.

    Article  Google Scholar 

  40. Cahir, C., Bennett, K., Teljeur, C., & Fahey, T. (2013). Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. BJCP, 1(77), 201–210. https://doi.org/10.1111/bcp.12161.

    Article  Google Scholar 

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Acknowledgements

The authors would like to extend heartfelt graciousness to all the participants and teachers who provided support at every step of the research.

Funding

The authors declare that they have not received any direct or indirect funding from any person or organization.

Author information

Affiliations

  1. Department of Pharmacy, Quaid-I-Azam University, Islamabad, 45320, Pakistan

    Muhammad Saqlain, Hussain Ali & Sohail Kamran

  2. College of Pharmacy, Jouf University, Sakaka, Aljouf, 72388, Saudi Arabia

    Muhammad Usman Munir

  3. KRL Hospital, Islamabad, Pakistan

    Shah Jahan

  4. Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, 20157, Milan, Italy

    Faizan Mazhar

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  1. Muhammad Saqlain
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  2. Hussain Ali
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  4. Muhammad Usman Munir
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  5. Shah Jahan
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Contributions

MS conceptualized and designed the study, interpreted the data, drafted the manuscript, and revised and approved the final manuscript as submitted. SK participated in the conceptualization and design of the study, carried out the initial analyses, revised the manuscript, and approved the final manuscript as submitted. SJ participated in the conceptualization and design of the study, analysis, and interpretation of the data, revised the article, and approved the final article as submitted. MUM participated in the conceptualization and design of the study, analysis, and interpretation of the data, revised the article, and approved the final article as submitted. HA participated in the conceptualization and design of the study, participated in the analysis and interpretation of the data, coordinated and supervised data collection, critically reviewed the manuscript, and approved the final manuscript as submitted. FM conceptualized and designed the study, interpreted the data, coordinated and supervised the data collection, critically reviewed the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Faizan Mazhar.

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Conflict of interest

All authors approve this version of the manuscript. None of authors have any kind of conflict of interest to declare.

Ethical approval

The study protocol was approved by an Ethical Review Board of Pakistan Institute of Medical Sciences (PIMS) Hospital (1-1/2015/ERB/SZABMU/229).

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Saqlain, M., Ali, H., Kamran, S. et al. Potentially inappropriate medications use and its association with health-related quality of life among elderly cardiac patients. Qual Life Res 29, 2715–2724 (2020). https://doi.org/10.1007/s11136-020-02530-5

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  • DOI: https://doi.org/10.1007/s11136-020-02530-5

Keywords

  • Potentially inappropriate medications
  • Cardiovascular disease
  • Elderly
  • Health related quality of life
  • Patient safety