Polypharmacy Patterns: A Decade-Long Comparison Among Elderly Cardiac Patients with Clinical Pharmacist Involvement at a University Hospital in Riyadh, Saudi Arabia

Abstract

Background: Polypharmacy is increasingly common among older adults, especially those with multimorbidity & chronic CVD. It heightens the risk of adverse drug reactions, drug–drug interactions, hospitalizations, & mortality. Clinical pharmacy services aim to optimize pharmacotherapy & ensure medication safety. In Saudi Arabia, although clinical pharmacy services are expanding, few long-term studies have evaluated their impact on prescribing practices & polypharmacy.

Aim: This study assessed polypharmacy prevalence in elderly cardiac patients in 2025, a decade after implementing clinical pharmacy services, evaluated changes in prescription patterns, clinical characteristics, and medication appropriateness before and after service integration.

Methods: A comparative, ambi-spective observational study was conducted at King Fahad Cardiac Center (KFCC) from May 2024 to May 2025. Eligible participants were cardiac outpatients aged ≥65 years on ≥5 medications. Prescriptions were screened. Patients with complete demographic and medication data were included. Data were sourced from electronic records & pharmacy databases. The exposure variable was the implementation of clinical pharmacy services in 2015, creating pre- and post-2015 cohorts. Primary outcomes included polypharmacy prevalence, potentially inappropriate prescriptions (PIPs), &prescribing trends. Statistical analyses were performed using chi-square and t-tests (p<0.05).

Results: Out of 1,174 prescriptions analysed, 88.9% were post-2015. Post-intervention,patients had fewer comorbidities, &prescriptions for those >80 years declined (p<0.05). Cardiovascular drugs remained the most prescribed. Polypharmacy slightly increased post-2015, but PIPs remained low and stable. Prescription volumes rose significantly after 2015, peaking in 2018. Temporal shifts included higher workloads on Saturday & Sundays and a prescription peak in March.

Conclusions: Clinical pharmacy services were associated with improved prescribing practices and reduced comorbidity burden. Despite a slight rise in polypharmacy, PIPs remained minimal, highlighting the role of clinical pharmacists in promoting safe and effective medication use in elderly cardiac patients.