MULTIPLE DISEASES AND POLYPHARMACY IN THE ELDERLY CARDIOVASCULAR DISEASE PATIENTS: CHALLENGES FOR THE INTERNIST WITH A NEED FOR AN EFFECTIVE SOLUTION

2016-11-08T01-11-23Z
Source: Indo American Journal of Pharmaceutical Research
Battu Rakesh*, Emilda .T. Joy, Jaladi Himaja, Dr.B.S.Suresha.
Polypharmacy is arguably one of the most pressing prescribing issues. There is no formally accepted definition, but it is usually considered as concurrent prescribing of at least four or five drugs. Multiple diseases and multimorbidity inevitably lead to the use of multiple drugs, a condition known as polypharmacy. Polypharmacy, a preventable and significant contributor to morbidity and mortality in geriatrics of cardiovascular disease. Aging seldom comes alone, often being accompanied by chronic diseases, co-morbidity, disability and frailty. Older people are particularly prone to adverse consequences due to age related physiological changes altering the pharmacokinetic and pharmacodynamics characteristics of many medicines. Over the last 2030 years, problems related to aging, multimorbidity, and polypharmacy have become a prominent issue in global healthcare. Therapy in Intensive Care Unit (ICU) often involves poly pharmacy and patients require close therapy monitoring. Polypharmacy also has the potential to influence many aspects of safe prescribing, including adverse drug reactions, risk of medication interactions, and adherence. Clinical pharmacists need to challenge the current culture of ratcheting up numbers of medications, and to increase awareness of the consequences of polypharmacy. This can be addressed, in part, through continued medical education, and also through clinical guidelines, particularly for common conditions affecting older patients. Proactively addressing the problem has significant potential to maximise quality of life for patients, help patients to manage their own medicines, reduce adverse effects, and encourage more rational and efficacious drug use. When individualization of therapy is warranted, the role of pharmacist can prove to be the best in achieving the therapeutic goals and improve the treatment outcomes of the patients. The main objectives of the study are to assess the prevalence of polypharmacy in cardiovascular disease patients ≥ 65 years and to assess the various causes for polypharmacy and to reduce and manage polypharmacy. This Cross Sectional study was carried out in the Department of General Medicine, MIMS Teaching Hospital, Mandya, Karnataka, using a well-designed patient data collection form. Among 114 cardiovascular disease patients analysed 65 patients were males (57.01%) and 49 (42.99%) were females. Among all admitted patients in ICCU, RICU, MICU and medical wards (male and female) for cardiac problems, patients were suffering mostly from co-morbid conditions and commonly found co-morbid condition was hypertension and diabetes mellitus, which supports the study that polypharmacy is extremely high in Hypertensive and Diabetic patients are more prone to high risk of complications (Drug-Drug Interactions and Adverse drug reactions). Polypharmacy was identified in 86 patients (75.43%) which include 51 (59.30%) males and 35 (40.70%) females. The study highlights the emergency department as a place where potential drug interactions can be identified in high-risk elderly patients. The presence of a Clinical Pharmacist would be of potential benefit to the process of identification of Polypharmacy and drug interactions. Furthermore, rational prescribing for the elderly should essentially involve listing potentially inappropriate medications, where the risks of administration may outweigh the benefits of administration. Polypharmacy places geriatric patients at risk of adverse events, functional decline, and geriatric syndromes. The strategies such as use of a risk stratification tool and application of palliative care principles represent initial steps forward to reduce polypharmacy.


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