To identify and prioritise the most appropriate (de)prescribing interventions in inpatient and outpatient hospital care to advance environmentally sustainable healthcare.

A modified RAND Delphi study.

Inpatient and outpatient hospital care in the Netherlands.

The Delphi panel consisted of 63 participants, comprising 36 physicians and 27 pharmacists working in Dutch hospitals.

Consensus on the appropriateness of (de)prescribing interventions for frequently used medications in inpatient and outpatient hospital care to advance environmentally sustainable healthcare and the prioritisation of interventions per care setting (inpatient/outpatient) and intervention type (deprescribing/sustainable dosage form), culminating in a top 20.

51 (de)prescribing interventions were identified for 18 medication classes, for which consensus on appropriateness was reached for 42 (82%). The top 20 highest ranked interventions were identified, starting with switching from intravenous to oral administration of paracetamol, stopping chronically used proton pump inhibitors without indication and initiating antibiotics orally in case of good bioavailability.

Most (de)prescribing interventions were considered appropriate for advancing sustainable medication use, highlighting support for their potential implementation to reduce the environmental burden of healthcare.

To describe the point prevalence of major ECG abnormalities, their coexistence with screen-detected cardiovascular disease (CVD) and the proportion requiring referral for cardiac work-up and interventions.

A population-based cohort study.

Primary and secondary care settings in Denmark.

Since 2014, all 67-year-old Danish men and women from Viborg municipality were invited to the ‘Viborg Screening Programme’ (VISP).

VISP includes screening for lower extremity artery disease (LEAD), carotid plaque (CP), abdominal aortic aneurysm (AAA), hypertension, diabetes mellitus and cardiac conditions.

A single resting 12-lead ECG was recorded and coded using the Minnesota criteria. Major ECG abnormalities were divided into rhythm and rate disorders, signs of myocardial damage and conduction disorders.

Over the first 5 years, 4612 (83.8% of those invited) were screened, with 4437 (96.4%) undergoing an ECG. We found major ECG abnormalities in 152 (3.4%), including 92 (2.1%) rhythm and rate disorders, 28 (0.6%) with signs of myocardial damage and 32 (0.7%) with conduction disorders. Fifty-nine (1.3%) had newly screen-detected ECG abnormalities, and 34 (0.8%) required intervention after cardiac consultation (32 medication adjustments and/or 11 advanced treatments). Participants with major ECG abnormalities had a higher frequency of coexisting CVD, including CP (46.4% vs 38.1%; p=0.040), LEAD (9.5% vs 5.3%; p=0.026) and AAA (2.7% vs 0.9%; p=0.032) and were also more common in men than in women (4.7% vs 2.2%; p

This study provides a detailed overview of major ECG abnormalities in a population-based cardiovascular screening context. Although the yield of ECG screening was low, ECG may still add value as a simple and low-cost tool within multimodal programmes, enabling timely detection and treatment.

NCT03395509.