Priority of prescribed medication in patients with heart failure in an Internal Medicine Department

Background and objective. Prescriptions provided to elderly patients with comorbidity on hospital discharge are usually complex. This study has aimed to know what proportion of drugs is considered essential by the prescribing doctors and the existing agreement on this qualification. Methods. Cross-sectional study. Setting: general acute care hospital. Study subjects: random sample of 60 hospital discharges in patients hospitalized due to heart failure between 2004 to 2006 with 540 prescribed drugs. Interventions: independent review by two internal medicine specialists and qualification of each of prescribed drugs as essential, advisable or not indicated. Calculation of the proportion of prescriptions according to priority, global and by therapeutic groups, and of the agreement between reviewers. Results. An average of 9 drugs (statistical deviation [SD] 2.4) and 13.5 daily takings (SD 4.6) by patient were prescribed on hospital discharge. The reviewers considered 68.4% of the prescriptions essential (95% confidence interval [CI], 65.5-71.2), advisable 25% (95% CI, 22.4-27.6) and not indicated 6.6% (95% CI, 5.1-8.1). An inverse relation between number of prescribed drugs and their proportion considered as essential was observed. Global agreement between reviewers in the classification of priority was relatively low: weighed Kappa 0.27 (95% CI, 0.19-0.36). More than 90% of the prescriptions were considered as essential in only 6 of the 15 therapeutic groups prescribed most, and good agreements in the qualification of their priority was only reached in 3 groups. Conclusions. A considerable proportion of the prescribed medication on hospital discharge in patients with heart failure was not considered essential. Agreement reached between the reviewers in this qualification was low.