Council Perspective Looks at Strategies For Deprescribing in Older Adults

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By implementing principles of deprescribing into daily patient care as a key component of an appropriate prescribing spectrum, the cardiovascular clinical community may be able to improve medication safety and reduce adverse drug reactions, particularly among older adults, according to a perspective from ACC's Geriatric Cardiology Council published May 20 in the Journal of the American College of Cardiology.

Ashok Krishnaswami, MBBS, FACC, et al., address the rationale, evidence and strategies for deprescribing cardiovascular and some noncardiovascular medications. They note that bridging the knowledge gap will lead to more meaningful collaborations between the cardiovascular team and clinical partners, as well as advance the view that discussions surrounding deprescribing are considered an integral component of routine cardiovascular care.

The authors explain that 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.

Scenarios where authors recommend considering deprescribing include present or expected adverse drug reactions, unnecessary polypharmacy, and the need to align medications with goals of care when life expectancy is reduced. The authors stress that cardiovascular clinicians must recognize deprescribing as an important resource to improve clinical care and enhance quality of life.

"Evidence to support cardiovascular medication deprescribing, tools to facilitate it, and models of care coordination between cardiovascular specialists and generalists are evolving," the authors conclude. "Further research will improve understanding of the deprescribing process and its impact on clinical care, patient-centered outcomes and costs."

Members of ACC's Geriatric Cardiology Section are invited to share their thoughts and continue the discussion on ACC's Member Hub!

Keywords: Life Expectancy, Cognition Disorders, Delirium, Dementia, Amnestic, Cognitive Disorders, Quality of Life, Polypharmacy, Drug-Related Side Effects and Adverse Reactions, Patient Care, Patient Care Planning

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