The prevalence and factors associated with potentially inappropriate medications in Chinese older outpatients with heart failure

Background: Potentially inappropriate medications (PIMs) can lead to adverse outcomes. This study aimed to investigate the prevalence of PIMs in older Chinese outpatients with heart failure according to the 2019 Beers criteria and the factors associated with PIMs.

Methods: A cross-sectional retrospective study was conducted using electronic medical data during January 1, 2020 to December 31, 2020 from 9 tertiary medical institutions in Chengdu, China. Outpatients aged 65 and above who were diagnosed with heart failure were included. The 2019 Beers criteria were used to evaluate the PIM status of older outpatients, and binary logistic regression was used to identify potential risk factors for PIMs.

Results: There were 3626 prescriptions. The prevalence of PIMs among older outpatients with heart failure was 67.98% according to the 2019 Beers criteria. Diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepine receptor agonist hypnotics, rivaroxaban, and dabigatran were the top five PIMs. The risks of PIMs were associated with the number of drugs prescribed and comorbidities. PIMs were shown to be more common in patients with polypharmacy (5-9 medications, OR: 10.403, 95% CI: 8.258-13.104, p < 0.001; ≥10 medications, OR: 35.018, 95% CI: 10.545-116.293, p < 0.001), valvular heart disease (OR: 1.537, 95% CI: 1.109-2.131, p = 0.010), and insomnia (OR: 2.655, 95% CI: 1.809-3.898, p < 0.001). While, medicare reimbursement (OR: 0.678, 95% CI: 0.570-0.808, p < 0.001) and visits to the geriatric departments (department of cardiology, OR: 1.687, 95% CI: 1.214-2.344, p = 0.002) were protective factors.

Conclusions: The prevalence of PIMs use was high among older Chinese outpatients with heart failure, according to this study. Multidisciplinary teams should cooperate to reduce PIMs in older adults.