Inappropriate prescribing in patients with cardiovascular diseases and non-cardiac multimorbidity (outpatient registry data)

Aim. To assess the prevalence of inappropriate prescribing (IP) in patients with cardiovascular diseases and concomitant non-cardiac multimorbidity using data from an outpatient registry.

Material and methods. The study sequentially included patients aged over 50 years with cardiovascular diseases and at least one concomitant non-cardiac condition requiring drug therapy. Patients completed original questionnaires regarding their medication therapy. Prescriptions were evaluated for inappropriateness based on their compliance with the official Summary of Product Characteristics (SmPC), clinical practice guidelines, and contemporary criteria for inappropriate prescribing.

Results. The study included 300 patients (120 men and 180 women). Patients had 2 to 11 comorbidities, with a median (Me) of 5 [4;6]. A total of 2961 medications were prescribed; 2071 prescriptions (69.9%) were classified as IP. At least one IP was identified in 99% of patients, Me 6 [4;9] per patient. The most common categories of IP were: misprescribing — 32% (of which more than half were combinations with potentially harmful drug-drug interactions), underprescribing — 20.1%, and overprescribing — 14%. Two additional types of IP were identified: “careless prescribing” (prescriptions lacking essential information such as dosage, frequency, or administration instructions), accounting for 18.5% of IPs, and “delegated prescribing” (cases where the physician transferred the responsibility for therapeutic decisions to the patient), accounting for 13.9% of IPs. The proportion of IP increased significantly with the total number of prescribed drugs. Of the 103 identified inappropriate drug combinations, 61% were prescribed by a single physician, while 38.4% resulted from uncoordinated prescribing by multiple physicians.

Conclusion. The prevalence of IP in patients with cardiovascular diseases and non-cardiac multimorbidity was substantial, at 70% of all prescriptions, consistent with rates in comparable international studies. Misprescribing was the predominant type of IP, with potentially harmful drug-drug interactions being the most common issue, accounting for 19.0% of all inappropriate prescriptions.

1. Damoiseaux-Volman BA, Medlock S, Raven K, Sent D, Romijn JA, van der Velde N, Abu-Hanna A. Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study. Eur J Clin Pharmacol. 2021;77(5):777-785. DOI:10.1007/s00228-020-03052-2.

2. Page RL 2nd, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010 7;5:75-87. DOI:10.2147/cia.s9564.

3. van Mil F. Drug-related problems: a cornerstone for pharmaceutical care. J Malta Coll Pharm Pract. 2005;10:5-8.

4. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 May 3;353:i2139. DOI:10.1136/bmj.i2139.

5. Schindler E, Richling I, Rose O. Pharmaceutical Care Network Europe (PCNE) drug-related problem classification version 9.00: German translation and validation. Int J Clin Pharm. 2021;43(3): 726-30. DOI:10.1007/s11096-020-01150-w.

6. Martsevich S. Yu., Tsaregorodtseva V. V., Kutishenko N. P., et al. Assessment of selftreatment in terms of inappropriate prescribing registry. Rational Pharmacotherapy in Cardiology. 2025;21(1):54-60 (In Russ.) DOI:10.20996/1819-6446-2025-3160.

7. O'Connor MN, Gallagher P, O'Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437-52. DOI:10.2165/11632610-000000000-00000.

8. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. DOI:10.1111/jgs.18372.

9. O'Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625-632. doi: 10.1007/s41999-023-00777-y. Epub 2023 May 31. Erratum in: Eur Geriatr Med. 2023 Aug;14(4):633. DOI:10.1007/s41999-023-00812-y.

10. Cooper JA, Ryan C, Smith SM, et al; (The PROMPT Steering Group). The development of the PROMPT (PRescribing Optimally in Middle-aged People's Treatments) criteria. BMC Health Serv Res. 2014;14:484. DOI:10.1186/s12913-014-0484-6.

11. Leal Rodríguez C, Kaas-Hansen BS, Eriksson R, et al. Drug interactions in hospital prescriptions in Denmark: Prevalence and associations with adverse outcomes. Pharmacoepidemiol Drug Saf. 2022;31(6):632-642. DOI:10.1002/pds.5415.

12. Hanlon JT, Artz MB. Drug-related problems and pharmaceutical care: what are they, do they matter, and what's next? Med Care. 2001 Feb;39(2):109-12. DOI:10.1097/00005650-200102000-00001.

13. van Mil JW, Westerlund LO, Hersberger KE, et al. Drug-related problem classification systems. Ann Pharmacother. 2004;38(5):859-67. DOI:10.1345/aph.1D182.

14. Huang CH, Umegaki H, Watanabe Y, et al. Potentially inappropriate medications according to STOPP-J criteria and risks of hospitalization and mortality in elderly patients receiving home-based medical services. PLoS One. 2019;14(2):e0211947. DOI:10.1371/journal.pone.0211947.

15. Khatter A, Moriarty F, Ashworth M, et al. Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: a repeated cross-sectional study. Br J Gen Pract. 2021;71(708):e491-e497. DOI:10.3399/BJGP.2020.1048.

16. Fahrni ML, Azmy MT, Usir E, et al. Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS One. 2019;14(7):e0219898. DOI:10.1371/journal.pone.0219898.

17. Mekonnen AB, Redley B, de Courten B, et al. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis. Br J Clin Pharmacol. 2021;87(11):4150-4172. DOI:10.1111/bcp.14870.