When cardiovascular medicines should be discontinued

European Heart Journal, Journal Year: 2024, Volume and Issue: 45(23), P. 2039 - 2051

Published: June 5, 2024

Abstract An integral component of the practice medicine is focused on initiation medications, based clinical guidelines and underlying trial evidence, which usually test addition novel medications intended for life-long use in short-term trials. Much less attention given to question medication discontinuation, especially after a lengthy period treatment, during patients age gets older diseases may either progress or new emerge. Given paucity data, offer little no guidance when how deprescribe cardiovascular medications. Such decisions are often left discretion clinicians, who, together with their patients, express concern potential adverse effects discontinuation. Even absence effects, continuation without any proven effect cause harm due drug–drug interactions, emergence polypharmacy, additional preventable spending already strained health systems. Herein, several classes discussed that opinion this author group should generally be discontinued, prevention harm, lack benefit, availability better alternatives.

Language: Английский

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Deprescribing for nursing home residents with limited life expectancy: A qualitative study to identify barriers and enablers for healthcare professionals

Geriatric Nursing, Journal Year: 2025, Volume and Issue: 62, P. 1 - 11

Published: Feb. 4, 2025

Language: Английский

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Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(10), P. e2337281 - e2337281

Published: Oct. 11, 2023

Little is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.To examine factors important to who disagree with a recommendation given by primary care physician hypothetical patient experiencing polypharmacy.This online, vignette-based survey study was conducted from December 1, 2020, March 31, 2021, participants 65 years or in United Kingdom, US, Australia, and Netherlands. The outcome of main disagreement recommendation. A content analysis subsequently free-text reasons provided strongly disagreed deprescribing. Data were analyzed August 22, 2022, February 12, 2023.Attitudes, beliefs, fears, recommended actions response recommendations.Of 899 included analysis, mean (SD) age 71.5 (4.9) years; 456 (50.7%) men. Attitudes, fears reported doubts (361 [40.2%]), valuing medications (139 [15.5%]), preference avoid change (132 [14.7%]). Valuing more commonly among compared those (48 205 [23.4%] vs 91 694 [13.1%], respectively; P < .001) had personal experience same medication class as vignette no (93 517 [18.0%] 46 318 [12.1%], = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), consideration preferences (137 [15.2%]) may increase their agreement interested additional (196 [28.2%] 29 [14.2%], .001), (117 [16.9%] 21 [10.2%], .02), (122 [17.6%] 15 [7.3%], .001).In this study, communication, strategies, disagreed. These findings suggest identifying degree could be used tailor patient-centered adults.

Language: Английский

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Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial

International Journal of Clinical Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 23, 2025

Language: Английский

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Development and Implementation of Deprescribing Guidelines

Advanced clinical pharmacy - research, development and practical applications/Advanced clinical pharmacy - research, development and practical applications, Journal Year: 2025, Volume and Issue: unknown, P. 93 - 130

Published: Jan. 1, 2025

Language: Английский

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Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

BMC Geriatrics, Journal Year: 2023, Volume and Issue: 23(1)

Published: July 12, 2023

Abstract Background Deprescribing, defined as discontinuing or reducing the dose of medications that are no longer needed for which risks outweigh benefits is a way to reduce polypharmacy. In 2022, US Deprescribing Research Network (USDeN) published recommendations concerning measurement outcomes deprescribing intervention studies. The objectives this systematic review were identify outcome categories used in trials and relate them previously recommendations. Methods We searched MEDLINE, Embase, PsychInfo, Cochrane library from January 2012 through 2022. Studies included if they randomized controlled evaluating intervention. After data extraction, categorized by type: medication outcomes, clinical system implementation other based on Results Thirty-six studies included. majority focused older adults nursing homes targeted inappropriate 20 studies, was review; seven educational informative; three their motivational interviewing patient empowerment. Thirty-one presented (primary 26 studies), 25 outcome, 18 an outcome. Only all four types 10 outcomes. Conclusions This provides update gold standard practice. Implementation need be developed specified facilitate these practices larger scale prioritized. Finally, new elements future real-life

Language: Английский

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Deprescribing medications among patients with multiple prescribers: A socioecological model

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(3), P. 660 - 669

Published: Nov. 9, 2023

Abstract Deprescribing is the intentional dose reduction or discontinuation of a medication. The development deprescribing interventions should take into consideration important organizational, interprofessional, and patient‐specific barriers that can be further complicated by presence multiple prescribers involved in patient's care. Patients who receive care from an increasing number may experience disruptions timely transfer relevant healthcare information, risk exposure to drug–drug interactions other medication‐related problems. Furthermore, fragmentation information across health systems contribute refilling discontinued medications, reducing effectiveness interventions. Thus, must carefully consider unique characteristics patients their ensure are successfully implemented. In this special article, international working group physicians, pharmacists, nurses, epidemiologists, researchers United States Research Network (USDeN) developed socioecological model understand how influence implementation intervention at individual, interpersonal, societal level. This manuscript also includes description concept outlines research agenda for future investigations consider. contained used as framework successful service effective possible.

Language: Английский

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Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study

BMJ Open, Journal Year: 2024, Volume and Issue: 14(10), P. e085569 - e085569

Published: Oct. 1, 2024

In the context of limited evidence on statin use in primary cardiovascular prevention older adults, we assessed physician perspectives decision-making about continuation or discontinuation this population.

Language: Английский

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Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation

BMC Primary Care, Journal Year: 2024, Volume and Issue: 25(1)

Published: June 11, 2024

Abstract Background Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult implement primary care. Training healthcare providers is needed enhance deprescribing eligible patients. This study will examine the effects a blended training program aimed at initiating conducting constructive consultations with Methods A cluster-randomized trial conducted which local pharmacy-general practice teams Netherlands randomized reviews patients as usual (control) or after receiving CO-DEPRESCRIBE (intervention). People 75 years older using specific cardiometabolic (diabetes drugs, antihypertensives, statins) review included. The intervention based on previous work applies models patient-centered communication shared decision making. It consists 5 modules supportive tools. outcome percentage least 1 deintensified. Secondary outcomes include patient involvement making, provider skills, health/medication-related outcomes, attitudes towards deprescribing, regimen complexity health-related quality life. Additional safety cost parameters collected. estimated that 167 per arm are final intention-to-treat analysis mixed model. Taking loss follow-up into account, 40 asked recruit 10 each. baseline 6-months assessment, process evaluation, cost-effectiveness conducted. Discussion hypothesis lead more proactive medication. By comprehensive an increase knowledge sustainable implementation care expected. Trial registration registered ClinicalTrials.gov (identifier: NCT05507177).

Language: Английский

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Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective and interventions to support a proactive approach

Expert Review of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: 17(8), P. 637 - 654

Published: Aug. 2, 2024

For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, rates these so-called cardiometabolic medications are low. A review challenges interventions addressing in this population pertinent.

Language: Английский

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