Abstract

Objectives: To quantify polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs) in pacemaker recipients aged ≥ 65 years and to assess associations with frailty (FRAIL), physical activity (IPAQ), medication adherence (MAT), and healthcare utilization over 6 months. Background: Polypharmacy is common in elderly patients with cardiac devices, but prospective data from European pacemaker clinics on frailty, physical activity, adherence, and prescribing quality are limited. Materials and methods: Prospective, single-center observational study in a Portuguese tertiary pacemaker outpatient clinic (n = 104). Participants (≥ 65 years) were assessed at enrolment and at 3 and 6 months. FRAIL, IPAQ, and MAT were recorded at each timepoint. Healthcare utilization was defined as emergency department visits and/or hospital admissions. STOPP/START v3 was applied descriptively at 6 months. Results: Mean age was 79.1 ± 7.5 years; 69.2% were men. Polypharmacy and hyperpolypharmacy were present in 49.0% and 38.5% at enrolment and 47.5% and 43.4% at 6 months. A higher number of chronic medications was associated with higher FRAIL scores, lower IPAQ scores and more frequent healthcare utilization, whereas MAT scores remained uniformly high. Cardiovascular drugs, diuretics, and proton-pump inhibitors (PPIs) were the most frequently used classes. STOPP/START identified potentially inappropriate medications (notably PPIs and benzodiazepines) and prescribing omissions according to START (notably cardiovascular therapies). Conclusion: Polypharmacy and hyperpolypharmacy are frequent and persistent in elderly pacemaker recipients and are associated with frailty, lower physical activity and higher healthcare utilization. Structured medication review during routine follow-up may help identify PIMs and PPOs and optimize pharmacotherapy.


Author Details

Authors

• Miguel Costa¹,²
• Natália António¹,²,³
• Carolina Félix¹,²
• Inês Jordão¹,²
• Patrícia Paiva¹,²
• Joana Guimarães³
• Diogo Fernandes³
• Lino Gonçalves³
• Francisco Parente¹

Departments

• ¹ Clinical Pharmacology Unit, and
• ² Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, and
• ³ Department of Cardiology, ULS Coimbra, E.P.E., Coimbra, Portugal

Address

Miguel Filipe Oliva Nogueira da Costa, MD, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
Email: [email protected]

Citation