Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

Figures & data

Table 1 Demographic and Clinical Characteristics of the Sample (n=447)

Characteristics	n (%)
Sex
Male	268 (60.0)
Female	179 (40.0)
Age (mean, SD)	71.5 (7.2)
60–64	88 (19.7)
65–69	112 (25.1)
70–74	102 (22.8)
75–79	63 (14.1)
80–85	65 (14.5)
85–90	17 (3.8)
Functional status
Robust (0)	183 (40.9)
Pre-frailty (1–2)	206 (46.1)
Frailty (3–5)	58 (13.0)
Comorbidities (median, IQR)	5 (3–6)
Hypertension	341 (76.3)
Dyslipidemia	307 (68.7)
Atherosclerosis	245 (54.8)
Type 2 diabetes mellitus	179 (40.0)
ACCI (median, IQR)	5 (3–6)
Low ACCI (2–4)	221 (49.4)
High ACCI (5–13)	226 (50.6)
Length of stay (median, IQR)	7 (7–9)
≥7 days	247 (55.3)
NYHA class
1	251 (56.2)
2	151 (33.8)
3	38 (8.5)
4	7 (1.5)

Abbreviations: ACCI, age-adjusted Charlson Comorbidity Index; NYHA, New York Heart Association; IQR, interquartile range.

Table 2 Number of Medications and PIMs at Discharge

	n (%)
Medications at discharge (median, IQR)	6 (5–8)
Range	1–17
Polypharmacy (≥6)	293 (65.5)
Number of patients prescribed with PIMs	170 (38.0)
1 PIM	119 (70.0)
2 PIMs	40 (23.5)
3–5 PIMs	11 (6.5)
Total number of PIMs	237
Medications that should be avoided	91 (38.4)
Medications that should be used with caution	116 (48.9)
Potentially clinical important drug-drug interactions to be avoided	30 (12.7)
Medications with drug-disease/syndrome interactions	0 (0.0)
Medications that should be adjusted along with kidney function	0 (0.0)

Abbreviations: PIMs, potentially inappropriate medications; IQR, interquartile range.

Table 3 PIMs That Should Be Avoided and to Be Used with Caution Using the 2019 Beers Criteria

The 2019 Beers Criteria	n (%)	Rationale
Medications that should be avoided	91 (38.4)
Benzodiazepines and Z-drugs	36 (15.2)	Cognitive impairment, fall, fracture and delirium
Long-acting sulfonylureas-glimepiride	31 (13.1)	Risk of severe prolonged hypoglycemia
PPI > 8 weeks in non-high-risk patients	15 (6.3)	Clostridium difficile infection and fractures
Peripheral α-1 blockers for hypertension	5 (2.1)	Risk of orthostatic hypotension
Antidepressants	2 (0.8)	Risk of anticholinergic effects
Digoxin>0.125 mg/d in heart failure	1 (0.4)	Risk of digitalism
Reserpine (>0.1 mg/d)	1 (0.4)	Orthostatic hypotension and bradycardia
Medications to be used with caution	116 (48.9)
NOAC-rivaroxaban and dabigatran	19 (8.0)	Risk of gastrointestinal bleeding
Diuretics-loop diuretics and thiazide	88 (37.1)	Risk of SIADH or hyponatremia
Carbamazepine	3 (1.3)
Sertraline	3 (1.3)
Citalopram	2 (0.8)
Mirtazapine	1 (0.4)

Abbreviations: Z-drugs, benzodiazepine receptor agonist hypnotics; PPI, proton-pump inhibitor; NOAC, new oral anticoagulant; SIADH, syndrome of inappropriate antidiuretic hormone secretion.

Table 4 Potentially Clinical Important Drug-Drug Interactions to Be Avoided Using the 2019 Beers Criteria

Object Drug/Class	Interacting Drug/Class	n (%)	Risk Rationale	Severity
Potassium-sparing diuretics	RAS inhibitors	23 (9.7)	Hyperkalemia or kidney injury	C^b
CNS-active drugs^a	≥2 CNS-active drugs	3 (1.3)	Fall and fracture	C
Warfarin	Amiodarone	2 (0.8)	Bleeding	D^c
Prednisone	Aspirin	1 (0.4)	Ulceration and bleeding	C
Doxazosin	Furosemide	1 (0.4)	Urinary incontinence	NA^d

Notes: ^aCNS-active drugs: antiepileptics, antipsychotics, benzodiazepine, benzodiazepine receptor agonist hypnotics, tricyclic antidepressant and serotonin-reuptake inhibitor; ^bC: monitor therapy; ^cD: consider therapy modification; ^dNA: no interaction.

Abbreviations: RAS, renin-angiotensin system; CNS, central nervous system.

Figure 1 Binary logistic regression of factors associated with PIMs.

Abbreviations: ACCI, age-adjusted Charlson Comorbidity Index; NYHA, New York Heart Association; OR, odds ratio; CI, confidence interval.