Background <p>Cardiovascular medications are frequently prescribed to patients with advanced cancer, even during the final weeks of life. However, little is known about their day-by-day use near death or how prescribing patterns may differ by hospice care type. This study aimed to characterize real-world prescribing patterns of these medications in the last 28 days of life, stratified by hospice care type.</p> Methods <p>This retrospective cohort study analyzed the patterns and timing of cardiovascular medication during the final 28 days of life among 8,719 hospitalized patients with advanced cancer at a tertiary hospital in Taiwan. Patients were categorized into three hospice care groups: no hospice care, hospice shared care, and hospice inpatient care. We assessed deprescribing, continued use, and new initiation of medications across care models.</p> Results <p>Compared to patients without hospice care, those receiving hospice inpatient care were significantly less likely to have newly initiated prescriptions for hypoglycaemic (OR = 0.37), lipid-lowering (OR = 0.54), and antithrombotic agents (OR = 0.41). Hospice shared care patients also showed lower use of hypoglycaemic agents (OR = 0.82), but higher rates of lipid-lowering prescriptions (OR = 1.89). Overall, cardiovascular medication use increased as death approached, but this trend was less pronounced in hospice groups.</p> Conclusions <p>Cardiovascular medications are frequently continued—and at times newly initiated—during the final weeks of life in patients with advanced cancer, especially in the absence of hospice involvement. These findings highlight distinct prescribing patterns across hospice care models and underscore the importance of timely medication review to balance treatment continuation against potential burden near the end of life.</p>