Introduction: There are a lack of potentially inappropriate medications (PIMs) predictors among the geriatric population with cardiovascular disease (CVD). Objective: This study was focussed on finding out the predictors and prevalence of PIMs use in the older adult patients hospitalized with cardiovascular disease. Methods: This prospective cross-sectional study included 250 older adult patients (mean age 69.03± 5.76 years) with the CVD having age 65 years or more, admitted in the cardiology/medicine department of a tertiary care hospital. PIMs were identified as per Beers criteria 2019. Binary Logistic regression analysis was used to determine the predictors of PIMs use in older adult patients. Results: Results indicate a very high PIM prescription rate of more than 62.4% (n= 156) with Proton pump inhibitor, short acting insulin according to sliding scale, Enoxaparin <30ml/min as the most commonly prescribed PIMs. On Binary logistic regression, important predictors for PIMs use were found to be females (odds ratio [OR] 2.36, 95% confidence interval (CI) 1.36- 4.09, P= 0.002), three diagnosis (OR 4.29, 95% CI 1.31- 14.0, P= 0.016), ≥4 diagnosis (OR 4.8, 95% CI 1.49- 15.44, P= 0.009), 7-9 days of hospital stay (OR 4.74, 95% CI 1.07- 20.96, P= 0.04), ≥ 9 medications per day (OR 0.09, 95% CI 0.01- 0.50, P= 0.006). Conclusion: The prevalence of PIMs in older adults with cardiovascular disease is very high, and females with CVD have emerged as a potential PIM indicator. The study also indicates a lack of awareness towards Beer criteria in health care workers (physicians/pharmacists/nursing staff) leading to PIM.