Defining inappropriate practices in prescribing for elderly people

Table 1: Inappropriate practices in prescribing drugs to treat cardiovascular diseases for elderly people, according to 32 members of a national consensus panel
Practice	Mean clinical significance rating*	Risk to patient	Alternative therapy	% of panel members who agreed with alternative
Prescription of ß-adrenergic blocking agent to treat hypertension for patients with a history of asthma or COPD†	3.83	May exacerbate respiratory disease	Another class of antihypertensive drugs	94
Prescription of ß-adrenergic blocking agent to treat angina for patients with a history of asthma, COPD or heart failure	3.63	May exacerbate respiratory disease or heart failure	Nitrate or calcium-channel blocker	94
Prescription of reserpine to treat hypertension	3.14	May cause depression and extrapyramidal effects in high dosages	Another antihypertensive drug	76
Prescription of disopyramide to treat atrial fibrillation	3.09	May cause anticholinergic side effects and sudden cardiac death	Digoxin Quinidine Procainamide	59 31 25
Prescription of thiazide diuretic to treat hypertension for patients with a history of gout	3.07	May precipitate or worsen gout	Another antihypertensive drug	74
Prescription of calcium-channel blocker to treat hypertension for patients with a history of heart failure	3.06	May worsen heart failure	Diuretic or ACE‡ inhibitor or both	94
Prescription of ß-adrenergic blocking agent to treat hypertension for patients with a history of heart failure	3.00	May worsen heart failure	Diuretic or ACE inhibitor Lower dosage of ß­adrenergic blocking agent and monitor effects	78 44
Long-term prescription of ß-adrenergic blocking agent to treat angina or hypertension for patients with a history of Raynaud disease	3.00	May worsen Raynaud disease	Calcium-channel blocker	91
*Rating scale from 1 (not significant) to 4 (highly significant). †COPD = chronic obstructive pulmonary disease. ‡ACE = angiotensin-converting-enzyme.

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