Predictors of drug–drug interactions in patients with heart failure
5 affiliations
- 1Department of Family Medicine, Primary Healthcare Center "Dr. Mustafa Šehović" Tuzla, Bosnia and Herzegovina
- 2Department of Cardiology, General Hospital "Prim. dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
- 3Faculty of Medical Sciences, University of Kragujevac, Serbia
- 4Faculty of Pharmacy, Department of Bromatology and Nutrition, University of Sarajevo, Bosnia and Herzegovina
- 5Faculty of Medicine, Department of Internal Medicine, University of Banja Luka, Bosnia and Herzegovina
Abstract
Introduction:: Heart failure (HF) patients are frequently exposed to polypharmacy, placing them at increased risk for drug–drug interactions (DDIs), especially in an outpatient setting where monitoring may be limited. The aim was to assess the prevalence and predictors of clinically relevant DDIs in HF patients and identify patterns associated with higher interaction risk.
Methods:: This cross-sectional observational study included 670 HF patients, treated at a single outpatient cardiology practice. Clinical and pharmacologic data were extracted from medical records. DDIs were identified using the Epocrates interaction checker and classified by severity. Logistic regression and generalized linear models were used to evaluate predictors of avoidable and monitor-required interactions.
Results:: No contraindicated DDIs were found, but 72.7% of patients had at least one avoidable interaction, and 100% had at least one requiring monitoring. Anticoagulants, mineralocorticoid receptor antagonists, proton pump inhibitor (PPI) use, older age, and HFmrEF and HFpEF phenotypes were significantly associated with increased risk of clinically relevant DDIs. Polypharmacy strongly influenced interaction burden, particularly when ramipril, metformin, atorvastatin, SGLT2 inhibitors, or PPIs were prescribed. Beta-blockers were mildly protective.
Conclusion:: Clinically significant DDIs are common in HF patients in outpatient care. Risk is highest in older patients, patients with comorbidities requiring multiple pharmacological agents, regimens, and patients with HFmrEF and HFpEF. Structured medication review and attention to high-risk drug combinations are essential to improve safety in HF pharmacotherapy.
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BibTeX
@article{tinjic2026predictors,
title = {{Predictors of drug–drug interactions in patients with heart failure}},
author = {Sabina Tinjić and Edin Begić and Slobodan Janković and Amila Turalić and Bojan Stanetić},
journal = {Journal of family medicine and primary care},
year = {2026},
month = jul,
doi = {10.4103/jfmpc.jfmpc_113_26},
url = {https://europepmc.org/article/PMC/PMC13722263},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Predictors of drug–drug interactions in patients with heart failure
AU - Sabina Tinjić
AU - Edin Begić
AU - Slobodan Janković
AU - Amila Turalić
AU - Bojan Stanetić
PY - 2026
DA - 2026/07/01
JO - Journal of family medicine and primary care
DO - 10.4103/jfmpc.jfmpc_113_26
UR - https://europepmc.org/article/PMC/PMC13722263
AB - Introduction:: Heart failure (HF) patients are frequently exposed to polypharmacy, placing them at increased risk for drug–drug interactions (DDIs), especially in an outpatient setting where monitoring may be limited. The aim was to assess the prevalence and predictors of clinically relevant DDIs in HF patients and identify patterns associated with higher interaction risk. Methods:: This cross-sectional observational study included 670 HF patients, treated at a single outpatient cardiology practice. Clinical and pharmacologic data were extracted from medical records. DDIs were identified using the Epocrates interaction checker and classified by severity. Logistic regression and generalized linear models were used to evaluate predictors of avoidable and monitor-required interactions. Results:: No contraindicated DDIs were found, but 72.7% of patients had at least one avoidable interaction, and 100% had at least one requiring monitoring. Anticoagulants, mineralocorticoid receptor antagonists, proton pump inhibitor (PPI) use, older age, and HFmrEF and HFpEF phenotypes were significantly associated with increased risk of clinically relevant DDIs. Polypharmacy strongly influenced interaction burden, particularly when ramipril, metformin, atorvastatin, SGLT2 inhibitors, or PPIs were prescribed. Beta-blockers were mildly protective. Conclusion:: Clinically significant DDIs are common in HF patients in outpatient care. Risk is highest in older patients, patients with comorbidities requiring multiple pharmacological agents, regimens, and patients with HFmrEF and HFpEF. Structured medication review and attention to high-risk drug combinations are essential to improve safety in HF pharmacotherapy.
SN - 2249-4863
SN - 2278-7135
ER -