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J Am Coll Cardiol. 2019 May 28;73(20):2584-2595. doi: 10.1016/j.jacc.2019.03.467.

Deprescribing in Older Adults With Cardiovascular Disease.

Author information

1
Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California. Electronic address: ashok.krishnaswami@kp.org.
2
Division of Geriatrics, University of California, San Francisco, California; Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California.
3
Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
4
Departments of Health Services, Policy, Practice and Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island.
5
Division of General Internal Medicine, University of California, San Francisco, California.
6
University of Houston College of Pharmacy, Houston, Texas.
7
Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Medicine, Oregon Health and Sciences University, Portland, Oregon.
8
Division of Cardiology, Columbia University Medical Center, New York, New York.
9
Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
10
Cardiovascular Division, Washington University, St. Louis, Missouri.
11
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.

Abstract

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.

KEYWORDS:

deprescribing; geriatrics; medications; multimorbidity; multiple chronic conditions; older adults; polypharmacy

PMID:
31118153
DOI:
10.1016/j.jacc.2019.03.467

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