Deprescribing in Older Adults With Cardiovascular Disease

Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing is particularly applicable to the commonly encountere...

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Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 73; no. 20; p. 2584
Main Authors: Krishnaswami, Ashok, Steinman, Michael A, Goyal, Parag, Zullo, Andrew R, Anderson, Timothy S, Birtcher, Kim K, Goodlin, Sarah J, Maurer, Mathew S, Alexander, Karen P, Rich, Michael W, Tjia, Jennifer
Format: Journal Article
Language:English
Published: United States 28.05.2019
Subjects:
Aged
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - epidemiology
Comorbidity
Deprescriptions
Drug-Related Side Effects and Adverse Reactions - epidemiology
Drug-Related Side Effects and Adverse Reactions - etiology
Global Health
Humans
Inappropriate Prescribing - prevention & control
Incidence
geriatrics
medications
multimorbidity
older adults
deprescribing
multiple chronic conditions
polypharmacy
ISSN:1558-3597, 1558-3597
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Summary:Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing is particularly applicable to the commonly encountered multimorbid older adult with cardiovascular disease and concomitant geriatric conditions such as polypharmacy, frailty, and cognitive dysfunction-a combination rarely addressed in current clinical practice guidelines. Triggers to deprescribe include present or expected adverse drug reactions, unnecessary polypharmacy, and the need to align medications with goals of care when life expectancy is reduced. Using a framework to deprescribe, this review addresses the rationale, evidence, and strategies for deprescribing cardiovascular and some noncardiovascular medications.
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2019.03.467