Many cardiologists support deprescription as a means to reduce polypharmacy

Deprescribing—or working with patients to reduce and optimize their medication load—could be fundamental to healthcare’s push toward more patient-centered care, according to a study published in the Journal of the American Geriatrics Society.

For the study, Parag Goyal, MD, MSc, of Weill Cornell Medicine, and colleagues surveyed geriatricians, general internists and cardiologists about their views on the practice of deprescribing. Deprescribing, defined in a more granular sense as working with patients to decide if they should stop taking one or more of their medications whose benefits no longer outweigh their risks, has become more popular in recent years as a way to reduce patients’ risk of polypharmacy.

Goyal et al.’s study dealt specifically with cardiovascular drugs like blood thinners and statins, since CV meds are among the most commonly prescribed in the U.S. and are often contributors to polypharmacy. The team sent a survey to 750 physicians, ultimately hearing back from 26% of the geriatricians, 26% of the general internists and 12% of the cardiologists they reached out to.

More than 80% of respondents said they’d recently considered deprescribing a cardiovascular medication, and the majority of those people cited adverse drug reactions as the reason they’d considered deprescription. Twenty-six percent of geriatricians, 13% of general internists and 9% of cardiologists said they’d recommended deprescribing a medication due to cognitive concerns.

When asked if they’d deprescribe a medication that was no longer expected to benefit a patient with a limited life expectancy, 26% of geriatricians, 13% of general internists and 9% of cardiologists said they might.

Across specialties, barriers to deprescribing included risking interfering with other physicians’ treatment plans and patient reluctance to stop taking prescribed medications. 

Goyal and co-authors said their survey suggests geriatricians, general internists and cardiologists all frequently consider deprescribing CV meds, but successfully implementing deprescribing practices will hinge on improved communication between physicians and their patients.

“Though these findings should be interpreted cautiously due to a low survey response rate, these findings indicate that the development and implementation of communication strategies across physician specialties and with patients are necessary to implement deprescribing cardiovascular medications as an effort to improve medication safety and mitigate polypharmacy,” the researchers wrote.