|First Author (Ref. #)||Acronym||Sample Size||Setting/Age||Inclusion Criteria||Medication Class||Deprescribing Process||Primary Outcome||Secondary Outcomes||Conclusions|
|Kutner et al. (33)||None||381||Palliative care research cooperative group member sites (U.S., Canada, Australia); 74 yrs (mean)||1 month ≥ life expectancy ≤1 yr, recent deterioration in functional status and statin use for primary or secondary CAD prevention, with no active CVD||Statins||Not provided||Proportion of deaths at 60 days||Number of non-statin medications, death, cardiovascular events, performance status, QOL, symptoms, and cost savings||Statin discontinuation was safe and did not increase mortality.|
Several secondary benefits: improvements in QOL, less non-statin medication use, decrease in medication costs
|Moonen et al. (34)||DANTE Study Leiden||356||General practices (the Netherlands); 81 yrs (mean)||Age ≥75 yrs with mild cognitive impairment||Anti-HTN agents||Deprescribing algorithm||Change in the overall cognition compound score||Changes in scores on cognitive domains, Geriatric Depression Scale–15, Apathy Scale, Groningen Activity Restriction Scale (functional status), and Cantril Ladder (QOL).||Deprescribing anti-HTN medications Did not improve cognitive, psychological, or general daily functioning, and did not increase the risk for adverse events|
|Luymes et al. (35)||ECSTATIC||1,067||Primary care clinics (the Netherlands); 54–55 yrs (mean)||Patients with low cardiovascular risk (ages 40-70 yrs, using statins and/or anti-HTN medications without an appropriate indication)||Lipid-lowering (predominantly statins), anti-HTN agents||Nurse prompting of physician to discuss prescribing with patients, followed by use of a guideline if deprescribing attempted||Difference in the increase in predicted (10-yr) CVD risk between control and per-protocol population||Systolic and diastolic blood pressures, cholesterol||The predicted CVD risk increased by 2.0% in the per protocol group compared with 1.9% in the usual care group, and this was within the noninferiority margin|
|Gulla et al. (36)||COSMOS∗||295||Nursing homes (Norway); 86–88 yrs (mean)||Nursing home units with LTC patients. Age ≥65 yrs and current use of anti-HTN medications||Anti-HTN agents||Systematic medication review whereby physician received support from peers (collegial mentoring)||Number of anti-HTN drugs||Systolic blood pressure, pulse||Decreased number of anti-HTN medications. No sustained difference in pulse or systolic pressure|
|Halliday et al. (37)||TRED-HF||51||Single center (United Kingdom); 54–56 yrs (median)||Previous diagnosis of DCM with LVEF ≤40%, no current symptoms of HF; current HF therapy; normal LVEDVi; NT-pro-BNP <250 ng/l||Heart failure medications||Random treatment assignment; supervised, step-wise reduction in medications over 16 weeks||Relapse of DCM within 6 months||Composite safety outcomes (cardiovascular mortality, major adverse cardiovascular events, and unplanned cardiovascular hospital admission) and the occurrence of sustained atrial or ventricular arrhythmias; other individual outcomes||Approximately 40% of patients deemed recovered from DCM will relapse following treatment withdrawal. Current recommendation is to continue treatment indefinitely|
|Ongoing study||RETREAT-FRAIL||∼1,100||Nursing homes (France); ≥80 yrs||Ongoing study||Anti-HTN agents||Unknown||All-cause mortality during a follow-up period of 24 months minimum to 48 months maximum||Unknown||Ongoing study|
Included are published or ongoing randomized controlled trials (RCTs) of deprescribing-related interventions that are focused on cardiovascular medication classes from September 1965 to the present. “Deprescribing-related” refers to a spectrum of deprescribing studies (individual medications, medication groups, specific protocols or algorithms, tools, etc.).
CAD = coronary artery disease; CVD = cardiovascular disease; DCM = dilated cardiomyopathy; HF = heart failure; HTN = hypertension; LTC = long-term care; LVEF = left ventricular ejection fraction; LVEDVi = left ventricular end-diastolic volume indexed; NT-pro-BNP = N-terminal pro–B-type natriuretic peptide; QOL = quality of life.
↵∗ Multicenter, cluster-randomized, controlled trial.