title: [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].
abstract: OBJECTIVE
  Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria.
  
  
  METHODS
  A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed.
  
  
  RESULTS
  Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure.
  
  
  CONCLUSIONS
  Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients' comorbidities and/or characteristics.
authors.affiliation: Groupe hospitalier du centre Alsace, département de gériatrie, 68000 Colmar, France.
authors.forename: Élodie
authors.initials: É
authors.lastname: Gentes
authors.affiliation: Groupe hospitalier du centre Alsace, département de gériatrie, 68000 Colmar, France.
authors.forename: Maurice
authors.initials: M
authors.lastname: Hertzog
authors.affiliation: Hôpitaux universitaires de Strasbourg, hôpital de la Robertsau, pôle de gériatrie, 67000 Strasbourg, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogel
authors.affiliation: Centre Nescens de médecine préventive, clinique de Genolier, 1272 Genolier, Suisse; Cambridge campus, Anglia Ruskin university, health and wellbeing academy, E Road, Cambridge CB1 1PT, Royaume-Uni; Health and wellbeing academy. Anglia Ruskin University, Cambridge Campus, E Rd, Cambridge CB1 1PT, Royaume-Uni. Electronic address: polang@nescens.com.
authors.forename: Pierre Olivier
authors.initials: PO
authors.lastname: Lang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006767:Hospitals, District; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D019338:Polypharmacy; D015995:Prevalence
chemical_list: D002317:Cardiovascular Agents