Potentially inappropriate medications for patients with heart failure and risk of hospitalization from heart failure:: A case-control study from Thailand

Background: Thailand have developed a list of potentially inappropriate medications for patients with heart failure (PIMHF). However, its association with clinical outcomes has not been evaluated in real-world clinical practice. Objective: To examine the association between the prescription of any PIMHF and hospitalization from heart failure (HF). Methods: A 1:1 matched case-control study was conducted. Data on HF patients visiting the study hospitals during 2017-2019 were obtained from the electronic medical record database. Patients with a history of first hospitalization due to HF and those with a history of outpatient department visits or non-HF hospitalization were defined as cases and controls, respectively. The association of hospitalization from HF with the prescription of any PIMHF was expressed as the adjusted odds ratio (aOR) and 95% confidence interval (95%CI), calculated using a conditional logistic regression (CLR) model. Results: After matching, 1,603 pairs of case and control were generated for the analysis. In total, 21 of 47 PIMHF were found to have been prescribed. Compared with the reference group of patients not prescribed any of the 21 PIMHF, those who had been prescribed a PIMHF had an aOR of 1.47 [95%CI 1.02:2.13]. NSAIDs/COX-2 inhibitors, oral short-acting beta-2 agonists, medications that promote fluid overload, and medications that elevate blood pressure were the four medication classes associated with the increased risk of hospitalization from HF (aOR = 2.64, [95%CI 1.30:5.38], aOR = 4.87, [95%CI 1.17:20.29], aOR = 1.50, [95%CI 1.01:2.22], and aOR = 2.51, [95%CI 1.26:4.99], respectively). Conclusions: The prescription of any of the 21 PIMHF found to have been prescribed in this study may increase the risk of hospitalization from HF. The Thai PIMHF list may be used in pharmacy practice as an assessment tool for the appropriate use of medication in HF patients.