title: The St Vincent's potentially inappropriate medicines study: development of a disease-specific consensus list and its evaluation in ambulatory heart failure care.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bermingham
authors.forename: Mary
authors.initials: M
authors.lastname: Ryder
authors.forename: Bronagh
authors.initials: B
authors.lastname: Travers
authors.forename: Nuala
authors.initials: N
authors.lastname: Edwards
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lalor
authors.forename: Deirdre
authors.initials: D
authors.lastname: Kelly
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallagher
authors.forename: Rory
authors.initials: R
authors.lastname: O'Hanlon
authors.forename: Kenneth
authors.initials: K
authors.lastname: McDonald
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015897:Comorbidity; D032921:Consensus; D003697:Delphi Technique; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology
keywords: Co-morbidity; Delphi technique; Heart failure; Medicines management; Potentially inappropriate medicines