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Consensus validation of a screening tool for cardiovascular pharmacotherapy in geriatric patients: the RASP_CARDIO list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients)

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Key summary points

AbstractSection Aim

To update and validate the content of the cardiovascular segment of the RASP list, a previously validated explicit screening tool to improve geriatric polypharmacy.

AbstractSection Findings

A three-step process was followed, starting with the tool update based on new literature and clinical experience. Next, internal discussions with four cardiologists and one cardiologist-internal medicine physician were held to finalize the construct and a Delphi consensus method was applied with the input of 17 geriatricians, cardiologists, an internal medicine physician and pharmacists to end up with a final construct with high agreement.

AbstractSection Message

To support health care professionals in reviewing cardiovascular therapy in geriatric patients, we have worked out a valid screening tool, the RASP_CARDIO list, which identifies 95 clinically relevant instances of potentially inappropriate over-, under- or misuse of cardiovascular medications.

Abstract

Purpose

Cardiovascular agents commonly used in geriatric patients, are linked to potentially avoidable harm and might hence be a suitable substrate for medication review practices. Therefore, we sought to update and validate the content of the cardiovascular segment of the previously published Rationalization of Home Medication by an Adjusted STOPP list in Older Patients (RASP) List.

Methods

A three-step study was conducted by the pharmacy department in collaboration with the geriatric medicine and cardiology department at the University Hospitals Leuven, Belgium. First, the cardiovascular segment of the RASP list version 2014 was updated taking into account published research, other screening tools and the input of end-users. Secondly, this draft was reviewed during three panel discussions with five expert cardiologists and three clinical pharmacists, all of whom had relevant expertise in geriatric pharmacotherapy. Thirdly, the content was validated using a modified Delphi Technique by a panel of European hospital pharmacists, cardiologists, geriatricians and an internal medicine physician.

Results

After the first and second step, the RASP_CARDIO list comprised 94 statements. Consensus (≥ 80% agreement) of all statements and one new statement about gliflozins in heart failure was achieved by a panel of seventeen experts across four European countries after two validation rounds. The final construct comprised a list of 95 statements related to potentially inappropriate prescribing of cardiovascular agents.

Conclusion

The RASP_CARDIO list is an updated and validated explicit screening tool to optimize cardiovascular pharmacotherapy in geriatric patients.

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References

  1. Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, Lopez-Verde F, Pico-Soler V, Leiva-Fernandez F et al (2020) Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: a cross-sectional study. PLoS ONE 15(8):e0237186

    Article  CAS  Google Scholar 

  2. Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C et al (2015) Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open 5(12):e009235

    Article  Google Scholar 

  3. Mugada V, Bhagavathi KC, Sagina P, Karnataka K, Ravada S, Kancharapu RM (2021) Potentially inappropriate medications, drug-drug interactions, and prescribing practices in elderly patients: a cross-sectional study. Rev Assoc Med Bras 67(6):800–805

    Article  Google Scholar 

  4. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D et al (2015) Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 175(5):827–834

    Article  Google Scholar 

  5. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370(9582):173–184

    Article  Google Scholar 

  6. Van der Linden L (2018) Improving drug use in older adults during hospital stay. 1–220

  7. Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K (2015) Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol 71(12):1415–1427

    Article  Google Scholar 

  8. Gallagher PF, O’Connor MN, O’Mahony D (2011) Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89(6):845–854

    Article  CAS  Google Scholar 

  9. Mertens B, Hias J, Hellemans L, Walgraeve K, Spriet I, Tournoy J et al (2022) Drug-related hospital admissions in older adults: comparison of the Naranjo algorithm and an adjusted version of the Kramer algorithm. Eur Geriatr Med 13(3):567–577

    Article  Google Scholar 

  10. Artikel II van het Koninklijk Besluit houdende vaststelling eensdeels, van de normen waaraan het zorgprogramma voor de geriatrische patiënt moet voldoen om te worden erkend en, anderdeels, van bijzondere aanvullende normen voor de erkenning van ziekenhuizen en ziekenhuisdiensten, 2007 (http://www.ejustice.just.fgov.be/eli/besluit/2007/01/29/2007022208/justel)

  11. Aguiar JP, Marques JG (2021) Utility and limitations of a screening tool of older person’s prescription among psychiatric elder patients: a comprehensive review. Aging Health Res. 1(3):100031

    Article  Google Scholar 

  12. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM, Group HS (2008) Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 168(17):1890–1896

    Google Scholar 

  13. Lavan AH, Gallagher PF, O’Mahony D (2016) Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging 11:857–866

    Google Scholar 

  14. Onder G, Landi F, Fusco D, Corsonello A, Tosato M, Battaglia M et al (2014) Recommendations to prescribe in complex older adults: results of the CRIteria to assess appropriate medication use among elderly complex patients (CRIME) project. Drugs Aging 31(1):33–45

    Article  Google Scholar 

  15. Wehling M (2011) Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc 59(2):376–377

    Article  Google Scholar 

  16. Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G et al (2011) The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med 171(6):550–556

    Article  Google Scholar 

  17. Raza JA, Movahed A (2002) Use of cardiovascular medications in the elderly. Int J Cardiol 85(2):203–215

    Article  Google Scholar 

  18. Walgraeve K, Van der Linden L, Flamaing J, Fagard K, Spriet I, Tournoy J (2018) Feasibility of optimizing pharmacotherapy in heart failure patients admitted to an acute geriatric ward: role of the clinical pharmacist. Eur Geriatr Med 9(1):103–111

    Article  Google Scholar 

  19. Ayan M, Pothineni NV, Siraj A, Mehta JL (2016) Cardiac drug therapy-considerations in the elderly. J Geriatr Cardiol 13(12):992–997

    CAS  Google Scholar 

  20. Van Der Linden L, Hias J, Walgraeve K, Loyens S, Flamaing J, Spriet I et al (2021) Factors associated with the number of clinical pharmacy recommendations: findings from an observational study in geriatric inpatients. Acta Clin Belg 76(2):119–126

    Article  Google Scholar 

  21. Morabet NE, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA et al (2018) Prevalence and preventability of drug-related hospital readmissions: a systematic review. J Am Geriatric Soc 66(3):602–608

    Article  Google Scholar 

  22. Ravn-Nielsen LV, Duckert ML, Lund ML, Henriksen JP, Nielsen ML, Eriksen CS et al (2018) Effect of an in-hospital multifaceted clinical pharmacist intervention on the risk of readmission: a randomized clinical trial. JAMA Intern Med 178(3):375–382

    Article  Google Scholar 

  23. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H et al (2009) A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 169(9):894–900

    Article  Google Scholar 

  24. O'Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Jose Cruz-Jentoft A, Cherubini A, Fordham R, Byrne S, Dahly D, Gallagher P, Lavan A, Curtin D, Dalton K, Cullinan S, Flanagan E, Shiely F, Samuelsson O, Sverrisdottir A, Subbarayan S, Vandaele L, Meireson E, Montero-Errasquin B, Rexach-Cano A, Correa Perez A, Lozano-Montoya I, Vélez-Díaz-Pallarés M, Cerenzia A, Corradi S, Soledad Cotorruelo Ferreiro M, Dimitri F, Marinelli P, Martelli G, Fong Soe Khioe R, Eustace J (2020) Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 49(4):605–614 

    Article  Google Scholar 

  25. Blum M R, Sallevelt B T G M, Spinewine A, O'Mahony D, Moutzouri E, Feller M et al (2021) Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial BMJ 374:n1585

    Article  Google Scholar 

  26. Dautzenberg L, Bretagne L, Koek HL, Tsokani S, Zevgiti S, Rodondi N et al (2021) Medication review interventions to reduce hospital readmissions in older people. J Am Geriatr Soc 69(6):1646–1658

    Article  Google Scholar 

  27. Kempen T, Bertilsson M, Hadziosmanovic N, Lindner K, Melhus H, Nielsen E, Sulku J, Gillespie U (2021) Effects of hospital-based comprehensive medication reviews including postdischarge follow-up on older patients’ use of health care: a cluster randomized clinical trial. JAMA Netw Open 4(4):e216303

    Article  Google Scholar 

  28. Petrovic M, Somers A, Onder G (2016) Optimization of geriatric pharmacotherapy: role of multifaceted cooperation in the hospital setting. Drugs Aging 33(3):179–188

    Article  CAS  Google Scholar 

  29. Counter D, Millar JWT, McLay JS (2018) Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital. Br J Clin Pharmacol 84(8):1757–1763

    Article  Google Scholar 

  30. Van der Linden L, Decoutere L, Walgraeve K, Milisen K, Flamaing J, Spriet I et al (2017) Combined use of the rationalization of home medication by an adjusted STOPP in older patients (RASP) list and a pharmacist-led medication review in very old inpatients: impact on quality of prescribing and clinical outcome. Drugs Aging 34(2):123–133

    Article  Google Scholar 

  31. Van der Linden L, Hias J, Walgraeve K, Flamaing J, Tournoy J, Spriet I (2020) Clinical pharmacy services in older inpatients: an evidence-based review. Drugs Aging 37(3):161–174

    Article  Google Scholar 

  32. Lavan AH, Gallagher P, Parsons C, O’Mahony D (2017) STOPPFrail (screening tool of older persons prescriptions in frail adults with limited life expectancy): consensus validation. Age Ageing 46(4):600–607

    Google Scholar 

  33. Van der Linden L, Decoutere L, Flamaing J, Spriet I, Willems L, Milisen K et al (2014) Development and validation of the RASP list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients): a novel tool in the management of geriatric polypharmacy. Eur Geriatr Med 5(3):175–180

    Article  Google Scholar 

  34. Van der Linden L, Hias J, Dreessen L, Milisen K, Flamaing J, Spriet I et al (2018) Medication review versus usual care to improve drug therapies in older inpatients not admitted to geriatric wards: a quasi-experimental study (RASP-IGCT). BMC Geriatr 18(1):155

    Article  Google Scholar 

  35. Van der Linden L, Decoutere L, Beerten L, Delva T, Spriet I, Flamaing J et al (2019) External validation of a clinical pharmacy intervention in geriatric inpatients: a controlled study. Int J Clin Pharm 41(4):853–858

    Article  Google Scholar 

  36. Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, Dombrowski R et al (2019) American Geriatrics Society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67(4):674–694

    Article  Google Scholar 

  37. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44(2):213–218

    Article  Google Scholar 

  38. Stewart D, Gibson-Smith K, MacLure K, Mair A, Alonso A, Codina C et al (2017) A modified Delphi study to determine the level of consensus across the European union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLoS ONE 12(11):e0188348

    Article  Google Scholar 

  39. Hutchings A, Raine R, Sanderson C, Black N (2006) A comparison of formal consensus methods used for developing clinical guidelines. J Health Serv Res Policy 11(4):218–224

    Article  Google Scholar 

  40. Hias J, Van der Linden L, Walgraeve K, Lemper JC, Hellemans L, Spriet I, Tournoy J (2022) Optimizing pharmacotherapy on geriatric hospital units in Belgium - a national survey. Acta Clin Belg 77(2):321–328

    Article  Google Scholar 

  41. Hsu C-C, Sandford BA (2007) The Delphi technique: making sense of consensus: pract assessment. Res Eval 12(10):1–8

    Google Scholar 

  42. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP et al (2019) Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 381(17):1609–1620

    Article  CAS  Google Scholar 

  43. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C et al (2020) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 42(5):373–498

    Article  Google Scholar 

  44. Curtin D, Gallagher PF, O’Mahony D (2019) Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences. Ther Adv Drug Saf 10:2042098619829431.

    Article  Google Scholar 

  45. Nexus. Nexus Hospitals 2021 [Available from: https://www.nexushospitals.com.au/. Accessed 12 Sept 2022

  46. Quintens C, Verhamme P, Vanassche T, Vandenbriele C, Van den Bosch B, Peetermans WE et al (2022) Improving appropriate use of anticoagulants in hospitalised patients: A pharmacist-led Check of Medication Appropriateness intervention. Br J Clin Pharmacol 88(6):2959–2968

    Article  Google Scholar 

  47. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA et al (2019) Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381(21):1995–2008

    Article  CAS  Google Scholar 

  48. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P et al (2020) Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 383(15):1413–1424

    Article  CAS  Google Scholar 

  49. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al (2021) 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 42(36):3599–3726

    Article  CAS  Google Scholar 

  50. Aggarwal P, Woolford SJ, Patel HP (2020) Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics (Basel) 5(4):85

    Article  Google Scholar 

  51. Quintens C, De Rijdt T, Van Nieuwenhuyse T et al (2019) Development and implementation of “Check of Medication Appropriateness” (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance. BMC Med Inform Decis Mak 19:29

    Article  Google Scholar 

  52. Ivanova I, Elseviers M, Wauters M, Christiaens T, Vander SR (2018) European repository of explicit criteria of potentially inappropriate medications in old age. Geriatr Gerontol Int 18(8):1293–1297

    Article  Google Scholar 

  53. Hias J, Hellemans L, Laenen A, Walgraeve K, Liesenborghs A, De Geest S, Luyten J, Spriet I, Flamaing J, Van der Linden L, Tournoy J (2022) The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE (ASPIRE): Protocol for a randomized controlled trial. Contemp Clin Trials 119:106853

    Article  Google Scholar 

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Acknowledgements

We are thankful to the panel of experts during the validation process for their individual contributions to the validation of the RASP_CARDIO list.

Funding

Onderzoeksraad, KU Leuven, Fonds Wetenschappelijk Onderzoek, 11K7822N, Laura Hellemans, 11K7822N, Rik Willems.

Author information

Author notes

  1. Hannah De Schutter and Julie Hias Shared first co-authorship.

Authors and Affiliations

  1. Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Hannah De Schutter, Julie Hias, Laura Hellemans, Karolien Walgraeve & Lorenz Van der Linden

  2. Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Louvain, Belgium

    Julie Hias, Laura Hellemans & Lorenz Van der Linden

  3. Research Foundation Flanders, Brussels, Belgium

    Laura Hellemans

  4. Department of Public Health and Primary Care, University of Leuven, Louvain, Belgium

    Jos Tournoy

  5. Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium

    Jos Tournoy

  6. Department of Cardiovascular Diseases, University Hospitals Leuven, Louvain, Belgium

    Peter Verhamme, Peter Sinnaeve, Rik Willems, Walter Droogné, Christophe Vandenbriele, Lucas Van Aelst & Thomas Vanassche

  7. Department of Cardiovascular Sciences, University of Leuven, Louvain, Belgium

    Peter Verhamme, Peter Sinnaeve, Rik Willems, Walter Droogné, Christophe Vandenbriele, Lucas Van Aelst & Thomas Vanassche

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  1. Hannah De Schutter
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Corresponding author

Correspondence to Hannah De Schutter.

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Conflict of interest

Marisa Alcaide and Marta Caparros are employed by Fundacion Gregal. There are no other conflict of interest.

Ethical approval

The study was approved by the Ethical Committee (MP017238).

Informed consent

Informed consent was provided for the panel discussions.

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The list can be used by any healthcare provider, but the prescriber stays entirely responsible for the final decision of their prescription. The list has to be updated and reviewed regarding to actual published evidence.

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De Schutter, H., Hias, J., Hellemans, L. et al. Consensus validation of a screening tool for cardiovascular pharmacotherapy in geriatric patients: the RASP_CARDIO list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Eur Geriatr Med 13, 1467–1476 (2022). https://doi.org/10.1007/s41999-022-00701-w

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