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.