Prescribing Pattern in Geriatrics with Cardio Vascular Diseases using Beers Criteria

Aim: Cardiovascular disease (CVD) is a major health problem throughout the world and a common cause of premature morbidity and mortality. CVD is a general category of diseases that affects the heart and the circulatory system. The main aim of the study is to assess the prescribing pattern in geriatrics with cardiovascular diseases using beers criteria. Study Design: Prospective observational study. Results and Discussion: Total 132 patients, 12 dropouts due to lack of information. Out of 120 patients 69 Patients are identified as Male Patients and 51 Patients are Female. In 120 sample size Maximum No of Cases were found with Ischemic Heart disease (30.8%) Followed by myocardial infarction (24%) coronary artery disease (20%) congestive heart failure (13.3%) Unstable Angina (11.6%). In 120 Sample Size, Male Patients are Suffering More with Complications Compared to Female Patients. Original Research Article Kumar et al.; JPRI, 33(5): 6-11, 2021; Article no.JPRI.64605 7 Conclusion: In this Study with Assessing the Prescribing Pattern in Geriatrics with Cardio Vascular Diseases It was found that major complications seen in Male and Female Patients are Ischemic heart Disease with Left ventricular dysfunction Myocardial Infarction, Coronary Artery Disease, Angina, Congestive Cardiac Failure.


INTRODUCTION
Globally, the geriatric population is increasing in number with faster rate than any other age group, as a result of increased life expectancy and decreased fertility. The increase in number of elderly population has also increased more hospital admissions, longer duration of hospital stays and more extended medical treatment. Increase of worldwide burden of oldness associated chronic conditions such as heart disease, neurological disease, emphasis health care providers' to use their scientific knowledge and promote appropriate use of medicines to protect elderly patient from adverse effects of inappropriate medications. Appropriateness in healthcare has been defined as "the outcomes of process of decision making that maximizes net health gains within society's available resources". Appropriate prescribing also associated with reduction of over-use, under-use and misuse of treatment [1-3].
The assessment of geriatric pharmacotherapy intends to modify the existing geriatric care practice. In this context of medicine, the prescribing of medications is an elementary component of elderly health-care, and the optimization of medication prescription has become an important public health concern. There are different explicit criteria for the assessment of appropriateness of prescription in elderly. Some of them are now modified or merged with other. Currently, five tools are being used to evaluate inappropriate prescription in elderly. The Beer's Criteria 2003, improved prescribing in the elderly tool, health plan employers data and information set and screening tool for older persons prescriptions criteria are explicit approaches, while the Medication Appropriateness Index (MAI) is an implicit approach [4-6]. The main aim of the study is to assess the prescribing pattern in geriatrics with cardio vascular diseases using beers criteria.

Study Site
Prospective observational study.

Study Type
Total 132 patients, 12 dropouts due to lack of information. The study comprised of 120 Geriatric patients, among them 69 were males and 51 females. The present study was carried out for a period of six months from NOV-2019 to MAY -2020. The present study was conducted at Government General Hospital Ananthapuramu.

Study Procedure
Data would be collected from case history forms of the patients included in the study and data were analyzed by descriptive statistics using graph pad prism (bio statistical software).

RESULTS
Total 132 patients, 12 dropouts due to lack of information. A total of 120 patients were screened for assessing the prescribing pattern in geriatrics with CVD. It indicates the gender wise distribution of the participants. Among the 120 research subjects known male CVD patients are 69 (57.5%) and female CVD patients constitutes of the 51(42.5%). This study revealed that majority of the patients who got admitted in the hospital were in the age group between 61-70years (59%) followed by patients who were in the age group 71-80 years (27%) and the least comes under the range of above 81 years of age (13%). In age group 61-70 years, the incidence of CVD was found more in male patients (64.7%) than females (35.2%), in the age group 71-80 years and above 81 years more number of females (51.5%),(56.2%) were found compared to males (48.4%),(51.5%) respectively. The elderly population suffers from numerous CVDs, in this study, maximum number of cases were found with ischemic heart disease (30.8%) followed by myocardial infarction (24.1%),coronary artery disease (20%), congestive heart failure (13.3%) and Unstable

DISCUSSION
This study shows that prevalence of cardio vascular diseases is more in males than females; the majority age group is 61-70 years 30.8%  [7]. The elderly population suffers from numerous CVDs, in this study, maximum no of cases was found with IHD followed by MI, CAD, CHF and unstable angina This study had shown the patterns of CVD'S prevalent in geriatric patients, drug use among them and also suggests that drugs to be avoided in elderly are among the most frequent inappropriately prescribed drugs. Inappropriate ccurrence of ADRs t cause mortality and morbidity Beer's criteria is one of the powerful tool to access the use of potentially inappropriate The Beer's criteria are based on expert consensus developed through an extensive literature review with a bibliography and questionnaire. It is evaluated by nationally recognized experts in geriatric care, clinical pharmacology, and psychopharmacology using a modified Delphi technique. It is explicit in nature, being derived from published reviews, expert opinions and consensus techniques without clinical judgement about the presenting patient. Beer's et al, published this criteria in the United States in 1991 to determine potentially inappropriate prescribing of medication in elderly [11][12][13].
According to this, drugs were classified as inappropriate in three categories: 1) Drugs that generally should be avoided in older adults; 2) Drugs that exceed a maximum recommended daily dose; and 3) Drugs to be avoided in combination with specific co morbidity [14].

CONCLUSION
Inappropriate prescription may lead to the occurrence of ADRs in geriartrics that cause mortality and morbidity. Hence it is necessary to avoid the use of inappropriate medication in geriartrics to reduce adverse effects of drugs and further larger studies involving elderly patients in various departments are necessary to realise the impact of this serious problem and to make prescriptions more rational in this group of population.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline participant consent and ethical approval has been collected and preserved by the authors.