Prescription safety in elderly cardiology patients: a cross-sectional study

Introduction The cardiology inpatient population is becoming increasingly older and burdened with multiple comorbidities. Polypharmacy, defined as the use ≥5 medications, is common in this group and is associated with an increased risk of adverse drug events and drug–drug interactions. Older adults are particularly susceptible to medication-related iatrogenesis due to reduced physiological reserve, frailty, and multimorbidity. In 2023, the American Geriatrics Society updated the Beers Criteria for potentially inappropriate medication use in adults aged 65 years and older. Purpose To assess the safety of drug prescriptions in patients hospitalized in a cardiology department, focusing on drug–drug interactions and potentially inappropriate medications. Methods We retrospectively reviewed the medication charts of patients admitted to the Cardiology Department on three randomly selected, non-consecutive days between December 2024 and May 2025. Demographic and therapeutic data were collected. Drug–drug interactions were assessed using the UpToDate interaction checker. Medications potentially inappropriate were identified according to the 2023 Beers Criteria. Results A total of 51 patients were analysed, including 17 women (33.3%), with a mean age of 71.5 ± 13.6 years (range 25–89). Thirty-seven patients (72.5%) were aged ≥65 years (14 aged 65–74, 16 aged 75–84, and 7 aged ≥85). Main reasons for admission were heart failure (n = 19, 37.3%), myocardial infarction (n = 13, 25.5%), rhythm disturbances (n = 7, 13.7%), endocarditis (n = 5, 9.8%), and other causes (n = 7, 13.7%). Patients were prescribed a mean of 10.7 ± 3.3 drugs (range 4–18). Clinically significant type D (consider therapy modification) and/or X (avoid combination) drug interactions were identified in 32 patients, with 9 patients presenting more than one interaction. A total of 22 type D interactions were observed, including dapagliflozin + insulin (n = 8) and ticagrelor + aspirin (n = 6). Another 22 type X interactions were found, most commonly omeprazole + clopidogrel (n = 12) and ipratropium + quetiapine (n = 6) (table 1). Regarding potentially inappropriate medications, no patients ≥75 years were prescribed ticagrelor. Three patients ≥65 years were on combinations of three CNS depressants. Four patients ≥65 years were prescribed rivaroxaban, although a switch to apixaban would be preferable due to lower bleeding risk. Conclusion Hospitalization offers an opportunity to optimize prescribing safety in elderly patients through systematic medication review and deprescribing. Therapeutic decisions should be individualized, balancing risks and benefits, particularly in frail older adults. The inclusion of a clinical pharmacologist or a geriatric-trained clinician could help identify high-risk interactions and optimize prescribing practices. Although some potentially inappropriate drugs may be unavoidable, risk–benefit assessment is essential to improve prescribing safety.