Potentially inappropriate medications in older adults with heart failure: prevalence and predictors using the 2023 Beers Criteria
M Sheikh-TahaAbstract
Background
Population ageing is accompanied by increasing multimorbidity and polypharmacy, exposing older adults to adverse drug events, drug–drug interactions, falls, cognitive impairment, unplanned hospitalizations, and mortality. Age-related pharmacokinetic and pharmacodynamic changes further heighten these risks. The 2023 American Geriatrics Society Beers Criteria provide an evidence-based framework to identify potentially inappropriate medications (PIMs) in older adults, including drugs to avoid, use with caution, or adjust based on renal function or comorbid conditions. Heart failure (HF) is highly prevalent among older adults and frequently complicated by renal impairment and frailty; however, the burden and determinants of PIM use in this population remain insufficiently characterized.
Purpose
To determine the prevalence and independent predictors of PIM use among older patients with HF.
Methods
We conducted a retrospective cross-sectional study of 524 randomly selected adults aged ≥65 years admitted with HF to two hospitals in USA between 1 January 2020 and 31 May 2025. Home medication lists at admission were screened using the 2023 Beers Criteria. Demographic data, comorbidities, medication count, and serum creatinine were extracted from electronic medical records. PIMs were classified according to Beers domains: (i) medications to generally avoid, (ii) medications to avoid in specific diseases or syndromes, (iii) medications to use with caution, (iv) high-risk drug–drug interactions, and (v) medications requiring renal dose adjustment or avoidance. Univariate analyses and multivariable Poisson regression were performed to identify factors associated with PIM burden. Statistical significance was defined as p<0.05.
Results
A total of 524 patients were included (mean age 76.5 ± 8.5 years; 53.8% male). Participants had a mean of 6.2 ± 2.3 comorbidities, most commonly hypertension (76.7%), dyslipidemia (63.2%), and coronary artery disease (61.8%). The mean number of home medications was 11.0 ± 3.6 per patient. Ninety-one percent of patients (472/524) had at least one PIM (range 1–16). One in four home medications (1,508 of 5,759) met the 2023 Beers criteria. The distribution of PIMs across the five Beers Criteria domains is summarized in Table 1. Higher PIM burden was independently associated with chronic kidney disease, depression, benign prostatic hyperplasia, and increasing comorbidity burden (Poisson regression, p < 0.05 for each).
Conclusion
PIM use was highly prevalent in older adults hospitalized with HF and rose with comorbidity burden and specific clinical conditions. Routine Beers-based medication review at admission, followed by deprescribing and safer substitutions, warrants evaluation as a quality-of-care intervention.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.