Polymorbidity and Polypragmasia in High and Very High Cardiovascular Risk Patients

Abstract

Aim. Assessment of the level and structure of polymorbidity, features of pharmacotherapy therapy in patients of different age groups, belonging to the category of high and extremely high cardiovascular risk, observed in outpatient clinics.Material and methods. The single-stage study included 282 patients of high and very high cardiovascular risk who were divided into three groups: (1) age 45-59 years, (2) 60-74 years, (3) ≥75 years. The structure of polymorbidity and features of pharmacotherapy in different age groups patients were evaluated. The frequency of polypragmasia was determined, and treatment adequacy in patients over 65 years of age was analyzed using the STOPP / START criteria and the Beers criteria of 2019.Results. High and very high cardiovascular risk patients have been found to be highly polymorbid, polimorbidity level increasing with age. Thus, among elderly patients, ischemic heart disease, chronic heart failure (CHF) were more often detected, as well as a high frequency of concomitant and background conditions, especially bone and joint system involvement (osteoarthritis, rheumatoid arthritis). Polypragmasia (administration of ≥5 drugs) was detected in 150 patients (53.2%) and was more common among elderly patients. According to Beers criteria, there were 48 cases of inadequate medication prescribing in 46 (28.0%) elderly patients. According to 80 STOPP criteria, 75 cases of prescribing potentially non-recommended drugs to 55 patients (32.1%) were detected. According to 34 START criteria, 116 cases of non-prescribing of necessary drugs to 52 (30.4%) elderly patients were found. When assessing the frequency of prognosis modifying medication prescribing, patients with CHF in 107 (63.0%) cases received angiotensin converting enzyme inhibitors, and in 42 cases (24.5%) angiotensin II receptor antagonists had been prescribed.  Thus,  87.5%  CHF patients were receiving renin-angiotensin-aldosterone system blockers. Statins were administered in 225 (79.8%) cases, antiplatelet agents were pre-scribed in 157 (67.9%) cases, and 23 persons (9.9%) were on oral anticoagulants for atrial fibrillation.Conclusion. In the structure of the studied cohort most of the high and very high cardiovascular risk outpatients were polimorbid, elderly and senile. Polypragmasia has been detected in more than half of elderly outpatients (53%), irrational medication was found in 28% to 30% elderly patients. Most patients with CHF were on statins, antithrombotic therapy, and renin-angiotensin-aldosterone system blockers.