The American College of Cardiology, American Geriatrics Society, and National Institute of Aging are convening a conference on pharmacotherapy in older adults with cardiovascular disease. It’s encouraging to see such a diverse group of experts (physicians, nurses, pharmacists, policymakers, patients, funding agencies) working together on this topic. The objectives broadly are to identify gaps in knowledge around the issue of medication prescribing in older adults, and to identify a future research agenda through involving multiple stakeholders in the process.
One of the most interesting talks from Day 1 was on the concept of deprescribing: removing medications that are no longer effective or potentially harmful. This has been a principle within geriatrics for decades, but is only recently gaining traction within the cardiovascular community. As one example within cardiology, a relatively recent trial in JAMA Internal Medicine randomized patients with advanced illness to continuing their statin medication versus discontinuing it. They found no difference in survival after several months; and the “deprescribed” group actually had better quality of life scores and lower medication costs.
For widespread acceptance of the concept within cardiology, deprescribing will need to be studied in a variety of clinical settings – and these studies can be difficult to perform – but there is a crucial need to understand if and when to stop medications in our older patients. And as cardiologists, we may ultimately need to rethink what it means when we say “lifetime” for a particular medication.
By: John Dodson, MD