Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Eur J Heart Fail. 2014 Aug;16(8):915-22. doi: 10.1002/ejhf.132.
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.
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).
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.
心力衰竭（HF）患者可能面临开具潜在不适当药物（PIMs）的风险，但尚无特定疾病的清单可用于评估该人群中 PIM 的使用情况。本研究开发了一种共识潜在不适当心力衰竭药物（PIMHF）清单，并在门诊 HF 人群中对其进行了评估和比较。
使用多学科团队的改良 Delphi 方法编制共识 PIMHF 清单。该清单由 11 项组成。评估了 350 例患者的药物情况。中位随访时间为 1.8 年（四分位距 1.3-2.1 年），分析了共识 PIMHF 项目的使用与主要终点（死亡、急性住院或非计划门诊就诊）之间的关系。51 例（14.6%）患者被开具了≥1 种共识 PIMHF 药物。单变量分析显示，与未开具任何共识 PIMHF 药物的患者相比，开具≥1 种共识 PIMHF 药物的患者发生主要终点事件的可能性高 58%[95%置信区间（CI）为 1.02-2.45]。在调整年龄、性别和 HF 严重程度后，这种差异仍然存在[风险比（HR）1.88，95% CI 1.16-3.06]，与使用更通用的工具相比（HR 1.24，95% CI 0.83-1.84）。然而，当进一步调整以纳入合并症评分和多种药物治疗时，使用这两种工具均与结局无关（HR 1.40，95% CI 0.83-2.38；HR 1.05，95% CI 0.69-1.60）。
共识 PIMHF 清单提供了首个 HF 特定药物审查工具。这些结果为使用更具针对性、PIM 清单有限的工具来合理管理 HF 药物提供了一定支持。然而，还需要更多前瞻性研究来检验这些工具在实践中的应用。
