Comparative effectiveness of the Beers Criteria (2023) versus the STOPP (v3) in detecting potentially inappropriate medications in older adults with heart failure: a retrospective cross-sectional study.

Abstract

Introduction: The American Geriatrics Society (AGS) Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria are extensively utilized in identifying potentially inappropriate medications (PIMs) among older adults. Older adults with heart failure (HF) confront the dual challenge of polypharmacy and inadequate adherence to evidence-based medications, which further complicates their medication management and clinical outcomes.

Aim: To assess the effectiveness of the AGS Beers (2023) Criteria and the STOPP (v3) criteria in identifying PIMs among older adults with HF and to analyze patterns of polypharmacy and evidence-based medications.

Method: This retrospective study was conducted at a tertiary academic medical center in China and involved 1578 outpatients aged ≥ 65 years with HF who received at least one outpatient prescription between January 1 and December 31, 2023. Data on demographics, comorbidities, and prescribed medications were extracted from the hospital's electronic medical record (EMR) system. PIMs were identified with the AGS Beers (2023) Criteria and the STOPP (v3) criteria. The data were analyzed using descriptive statistics in Microsoft Excel.

Results: Polypharmacy and hyperpolypharmacy were prevalent among the patients, affecting 65.3% and 15.7% of the cohort, respectively. PIMs were identified in 75.5% of patients (1192/1578), with a total of 2128 PIM cases observed according to the Beers Criteria, with the most common PIM being rivaroxaban (32.3%). The STOPP (v3) criteria identified PIMs in 28.9% of patients (n = 471), with the most frequent PIMs being statin use in frail patients aged ≥ 85 years (26.8%) and prolonged use of proton-pump inhibitors (16.6%). Among all patients in our study, 61.6% received either an angiotensin-converting enzyme inhibitor, angiotensin-II receptor blocker, or angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI); 57.0% were prescribed β-blockers; and 32.6% used a sodium-glucose cotransporter 2 inhibitor.

Conclusion: While the Beers Criteria identified a greater number of PIMs in this study, both tools have differing strengths in detecting medication-related risks. Their combined use may provide a more holistic assessment of prescribing appropriateness. The widespread use of PIMs in older adults with HF, coupled with the frequent underuse of beneficial therapies, calls for systematic interventions. Pharmacist-led interventions and electronic decision-support systems that integrate evidence-based prescribing, deprescribing, and regular medication reviews are crucial for optimizing therapeutic outcomes in older adults with HF.