J Eval Clin Pract. 2025 Jun;31(4):e70190. doi: 10.1111/jep.70190.
ABSTRACT
OBJECTIVES: This study aimed to assess the effectiveness of pharmacist interventions to reduce the omission of evidence-based cardiovascular medication, as well as polypharmacy and promote the deprescribing of potentially inappropriate medications in hospitalised older patients diagnosed with cardiovascular diseases.
METHODS: This before-and-after study was conducted among patients aged ≥ 60 years (n = 319) at a cardiovascular hospital in Brazil. Pharmacists conducted medication reviews for these patients. The first prescription on hospital admission and that at discharge were collected and compared for prescribing omission, polypharmacy, and prescribing of potentially inappropriate medications.
RESULTS: The mean patient age was 68.9 (±6.2) years. The mean incidences of prescribing potentially inappropriate medications and omissions decreased from 0.90 at admission to 0.10 at discharge (p < 0.001) and from 0.65 to 0.30 (p < 0.001), respectively. The number of potentially inappropriate medications prescribed decreased significantly, from 291 at admission to 28 at discharge, reflecting a 90% reduction. Additionally, the mean number of medications prescribed decreased from 9.8 to 6.5 (p < 0.001).
CONCLUSION: This study emphasises the role of medication reviews by clinical pharmacists in reducing polypharmacy, prescribing omissions, and inappropriate prescribing in older adults with cardiovascular diseases, demonstrating that targeted pharmacist interventions improve medication safety.
TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT04800900).
PMID:40581959 | DOI:10.1111/jep.70190
