Author + information
- Ashok Krishnaswami, MD, MASa,b,∗ (, )@cardskrish@KPSanJose,
- Michael A. Steinman, MDc,d,
- Parag Goyal, MD, MSce,
- Andrew R. Zullo, PharmD, PhDf,g,
- Timothy S. Anderson, MDh,
- Kim K. Birtcher, PharmD, MSi,
- Sarah J. Goodlin, MDj,k,
- Mathew S. Maurer, MDl,
- Karen P. Alexander, MDm,
- Michael W. Rich, MDn,
- Jennifer Tjia, MD, MSCEo,
- Geriatric Cardiology Section Leadership Council, American College of Cardiology
- aDivision of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California
- bDepartment of Epidemiology and Biostatistics, University of California, San Francisco, California
- cDivision of Geriatrics, University of California, San Francisco, California
- dDivision of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California
- eDivision of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
- fDepartments of Health Services, Policy, Practice and Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- gCenter of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
- hDivision of General Internal Medicine, University of California, San Francisco, California
- iUniversity of Houston College of Pharmacy, Houston, Texas
- jGeriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon
- kDepartment of Medicine, Oregon Health and Sciences University, Portland, Oregon
- lDivision of Cardiology, Columbia University Medical Center, New York, New York
- mDivision of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- nCardiovascular Division, Washington University, St. Louis, Missouri
- oDepartment of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- ↵∗Address for correspondence:
Dr. Ashok Krishnaswami, Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California 95119.
• Multimorbid older adults with CVD are disproportionately affected by medication-related issues.
• Deprescribing is an integral component of good prescribing practice.
• Incorporating deprescribing into routine cardiovascular care can reduce treatment burden and morbidity in older adults.
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.
The views expressed in this paper by the American College of Cardiology’s Geriatric Cardiology Section Leadership Council does not necessarily reflect the views of the Journal of the American College of Cardiology or the American College of Cardiology.
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.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 22, 2019.
- Accepted March 12, 2019.
- Central Illustration
- Definition of Deprescribing
- Rationale for Deprescribing
- Ethical Basis for Deprescribing
- Triggers to Deprescribe
- Clinical Trials of Deprescribing
- Attitudes, Barriers, and Enablers to Deprescribing
- Steps to Deprescribe
- Framework for Deprescribing
- Tools Used for Deprescribing
- Deprescribing Workflow
- Payment for Deprescribing