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Review
. 2019 May 28;73(20):2584-2595.
doi: 10.1016/j.jacc.2019.03.467.

Deprescribing in Older Adults With Cardiovascular Disease

Ashok Krishnaswami  1 , Michael A Steinman  2 , Parag Goyal  3 , Andrew R Zullo  4 , Timothy S Anderson  5 , Kim K Birtcher  6 , Sarah J Goodlin  7 , Mathew S Maurer  8 , Karen P Alexander  9 , Michael W Rich  10 , Jennifer Tjia  11 ; Geriatric Cardiology Section Leadership Council, American College of Cardiology
Affiliations
Review

Deprescribing in Older Adults With Cardiovascular Disease

Ashok Krishnaswami et al. J Am Coll Cardiol. .

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.

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CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Overview of Deprescribing by the Cardiovascular Clinical Team
Deprescribing should incorporate a framework that includes the medical/surgical, physical, cognitive, and social domains. Steps 1 and 2 may be facilitated by using the deprescribing tools discussed in the text. See Table 6 for a real-world example. Based on Scott et al. (5) framework.
See this image and copyright information in PMC

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