TY - JOUR
T1 - Deprescribing in Older Adults With Cardiovascular Disease
AU - Geriatric Cardiology Section Leadership Council, American College of Cardiology
AU - Krishnaswami, Ashok
AU - Steinman, Michael A.
AU - Goyal, Parag
AU - Zullo, Andrew R.
AU - Anderson, Timothy S.
AU - Birtcher, Kim K.
AU - Goodlin, Sarah J.
AU - Maurer, Mathew S.
AU - Alexander, Karen P.
AU - Rich, Michael W.
AU - Tjia, Jennifer
N1 - Funding Information:
The current work was supported in part by National Institutes on Aging (NIA) grant # U13 AG047008 to Dr. Rich. Dr. Steinman was supported by National Institutes of Health grant AG-K24049057. Dr. Maurer was supported by NIA grant K24 AGO36778. Dr. Tjia was supported by the Cambia Health Foundation Sojourns Scholar Award; and has been a consultant to CVS Health and Omnicare Long Term Care Pharmacy. Dr. Zullo has received institutional research support from Sanofi Pasteur. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The current paper evolved from the “Pharmacotherapy in Older Adults with Cardiovascular Disease” conference sponsored by the American College of Cardiology, American Geriatric Society, and National Institutes of Aging held at ACC Heart House in Washington, DC, on February 6 to 7, 2017.
Publisher Copyright:
© 2019
PY - 2019/5/28
Y1 - 2019/5/28
N2 - 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.
AB - 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.
KW - deprescribing
KW - geriatrics
KW - medications
KW - multimorbidity
KW - multiple chronic conditions
KW - older adults
KW - polypharmacy
UR - http://www.scopus.com/inward/record.url?scp=85065645809&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.03.467
DO - 10.1016/j.jacc.2019.03.467
M3 - Review article
C2 - 31118153
AN - SCOPUS:85065645809
SN - 0735-1097
VL - 73
SP - 2584
EP - 2595
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -