New York—As pharmacists well know, polypharmacy can increase the risk of adverse drug reactions in older patients taking multiple medications. While deprescribing can be a viable solution, it hasn’t been clear how physicians view that option.

In an article published in the Journal of the American Geriatrics Society, researchers from Weill-Cornell Medicine in New York and Beth Israel Deaconess Medical Center in Boston and colleagues sought to determine how often physicians deprescribe cardiovascular medications in their practices and what they consider to be barriers to the practice.

To do that, they surveyed 750 geriatricians, general internists, and cardiologists, resulting in response rates of 26% for geriatricians, 26% for general internists, and 12% for cardiologists.

“Guideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults,” the authors write. “Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties.”

The electronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases went to a random sample of geriatricians, general internists, and cardiologists from the American College of Physicians.

Results indicate that more than 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. The most common reason for deprescribing for all specialties was adverse drug reactions.

Researchers point out that geriatricians also commonly reported deprescribing in patients who have limited life expectancy.

“Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians’ treatment plans and patient reluctance” to stop taking medications prescribed, the authors explain.

In hypothetical cases, more than 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were the most likely—and cardiologists the least likely—to consider deprescribing cardiovascular medications in cases of limited life expectancy (all, P <.001), such as:
• Recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists)
• Alzheimer’s dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists)
• Significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists)

“While barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied,” the authors conclude. “Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication.”

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