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Posted By: Daniel Thibodeau, MHP, PA-C
June 01, 2019
We all have patients in our practices who are older and on numerous medications. They are stabilizing their problems but are faced with the reality of nearing the end of their lives. In some cases, patients will have complaints that are related to adverse reactions. In other cases, the prescribing cascade of medications has occurred. The American College of Cardiology Section Leadership Council recently published recommendations for when to consider “deprescribing” a medication regimen. The council identified some triggers that would cause the practitioner to consider a de-escalation of medications—including adverse effects, polypharmacy, the prescribing cascade, and conditions related to end-of-life decision making and palliative care. The authors proposed a five-step process to consider. The five steps are:
1. Review and reconcile
2. Assess risk of adverse effects
3. Assess candidacy of individual medications
4. Prioritize drug discontinuation
5. Discontinue and monitor
These are important steps for all practitioners to consider when managing elderly or end-of-life patients. When seeing such patients, it is imperative for all of us to have frank conversations with them and their families to consider these steps and plan treatment appropriately.
- Krishnaswami A, Steinman MA, Goyal P. Deprescribing in older adults with cardiovascular disease. J Am Coll Cardiol. 2019:73;2584-2595.