Drug-related problems in geriatric cardiovascular patients – a hospital setting

Background Older patients with cardiovascular diseases frequently experience polypharmacy and its associated complications, including drug-related problems (DRPs) and potentially inappropriate medications (PIMs). Hospitalization and therapy modifications may further complicate therapy. Structured pharmacotherapy review conducted collaboratively by pharmacists and physicians may enhance medication safety in this population. Methods This subgroup analysis included 80 patients aged ≥ 65 years hospitalized at the Vascular Surgery Department of the National Institute of Cardiovascular Diseases in Bratislava, Slovakia. Medication reconciliation and comprehensive medication review were performed at admission and discharge by trained pharmacists in collaboration with treating physicians. DRPs were classified using the Pharmaceutical Care Network Europe v9.00 system and PIMs identified using the EU(7)-PIM list. Patients’ understanding of pharmacotherapy was assessed using a three-point comprehension scale. Admission and discharge data were compared using the paired Wilcoxon signed-rank test. Results The mean age was 71.4 ± 5.0 years, and polypharmacy was highly present. Pharmacist intervention was associated with a significant reduction in DRPs at discharge (p = 0.003) and a modest decrease in the number of medications (p = 0.01), but not PIMs. DRPs were most frequently associated with statins and proton pump inhibitors. Most pharmacist recommendations addressed prescribing-related issues, with an overall physician acceptance rate of 59.8%. Although nearly half of patients demonstrated good understanding of their pharmacotherapy, important knowledge gaps persisted. Conclusions A pharmacist-led, structured pharmacotherapy review conducted collaboratively with physicians was associated with fewer DRPs at discharge in older cardiovascular patients, supporting its role in improving medication safety in complex clinical settings.