Skip to main content
Top

15-10-2024 | Heart Failure | CE-REVIEW

Deprescribing strategies in older patients with heart failure

Authors: Gregorio Tersalvi, Vittorio Beltrani, Marco Peronti, Ludovico Furlan, Andrew Foy, Luigi Biasco

Published in: Internal and Emergency Medicine

Login to get access

Abstract

Older patients with heart failure are particularly vulnerable due to a wide range of associated comorbidities, disability, and frailty. This population often receives multiple prescriptions, increasing the risk of adverse drug reactions, non-adherence, and drug interactions. Deprescribing, which involves reducing the number of medications to the lowest clinically reasonable limit, has the potential to decrease the risk of drug interactions and enhance patients’ quality of life. Moreover, simplifying medication regimens may improve adherence to essential heart failure therapies. This scientific review aims to comprehensively examine deprescribing strategies in older patients with heart failure. It explores the rationale, challenges, benefits, and potential approaches to optimizing medication regimens in this vulnerable population. Furthermore, the review suggests a practical, step-by-step approach for performing deprescribing in older patients with heart failure.
Literature
2.
go back to reference Tersalvi G, Gasperetti A, Schiavone M et al (2021) Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 18:560–576PubMedPubMedCentral Tersalvi G, Gasperetti A, Schiavone M et al (2021) Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 18:560–576PubMedPubMedCentral
3.
5.
go back to reference Gnjidic D, Hilmer SN, Blyth FM et al (2012) Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 65:989–995PubMedCrossRef Gnjidic D, Hilmer SN, Blyth FM et al (2012) Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 65:989–995PubMedCrossRef
6.
go back to reference Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 18:891–975PubMedCrossRef Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 18:891–975PubMedCrossRef
8.
go back to reference Sukumar S, Orkaby AR, Schwartz JB et al (2022) Polypharmacy in older heart failure patients: a multidisciplinary approach. Curr Heart Fail Rep 19:290–302PubMedCrossRef Sukumar S, Orkaby AR, Schwartz JB et al (2022) Polypharmacy in older heart failure patients: a multidisciplinary approach. Curr Heart Fail Rep 19:290–302PubMedCrossRef
10.
go back to reference Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146-156PubMedCrossRef Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146-156PubMedCrossRef
11.
go back to reference Vitale C, Jankowska E, Hill L et al (2019) Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure. Eur J Heart Fail 21:1299–1305PubMedCrossRef Vitale C, Jankowska E, Hill L et al (2019) Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure. Eur J Heart Fail 21:1299–1305PubMedCrossRef
12.
go back to reference Visseren FLJ, Mach F, Smulders YM et al (2021) 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 42:3227–3337PubMedCrossRef Visseren FLJ, Mach F, Smulders YM et al (2021) 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 42:3227–3337PubMedCrossRef
13.
go back to reference Khan H, Kalogeropoulos AP, Georgiopoulou VV et al (2013) Frailty and risk for heart failure in older adults: the health, aging, and body composition study. Am Heart J 166:887–894PubMedCrossRef Khan H, Kalogeropoulos AP, Georgiopoulou VV et al (2013) Frailty and risk for heart failure in older adults: the health, aging, and body composition study. Am Heart J 166:887–894PubMedCrossRef
14.
go back to reference Denfeld QE, Winters-Stone K, Mudd JO et al (2017) The prevalence of frailty in heart failure: a systematic review and meta-analysis. Int J Cardiol 236:283–289PubMedPubMedCentralCrossRef Denfeld QE, Winters-Stone K, Mudd JO et al (2017) The prevalence of frailty in heart failure: a systematic review and meta-analysis. Int J Cardiol 236:283–289PubMedPubMedCentralCrossRef
15.
go back to reference Bielecka-Dabrowa A, Ebner N, Santos MR et al (2020) Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 22:ejhf.2011CrossRef Bielecka-Dabrowa A, Ebner N, Santos MR et al (2020) Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 22:ejhf.2011CrossRef
16.
go back to reference Hamada T, Kubo T, Kawai K et al (2023) Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction. ESC Heart Fail 10:223–233PubMedCrossRef Hamada T, Kubo T, Kawai K et al (2023) Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction. ESC Heart Fail 10:223–233PubMedCrossRef
17.
go back to reference Lee Y-C, Lin JK, Ko D et al (2023) Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction. J Am Geriatr Soc 71:3110–3121PubMedPubMedCentralCrossRef Lee Y-C, Lin JK, Ko D et al (2023) Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction. J Am Geriatr Soc 71:3110–3121PubMedPubMedCentralCrossRef
18.
go back to reference Dewan P, Jackson A, Jhund PS et al (2020) The prevalence and importance of frailty in heart failure with reduced ejection fraction—an analysis of PARADIGM-HF and ATMOSPHERE. Eur J Heart Fail 22:2123–2133PubMedCrossRef Dewan P, Jackson A, Jhund PS et al (2020) The prevalence and importance of frailty in heart failure with reduced ejection fraction—an analysis of PARADIGM-HF and ATMOSPHERE. Eur J Heart Fail 22:2123–2133PubMedCrossRef
19.
go back to reference Yang X, Lupón J, Vidán MT et al (2018) Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis. J Am Heart Assoc 7:e008251PubMedPubMedCentralCrossRef Yang X, Lupón J, Vidán MT et al (2018) Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis. J Am Heart Assoc 7:e008251PubMedPubMedCentralCrossRef
20.
go back to reference Ohashi K, Matsue Y, Maeda D et al (2024) Impact of multidomain frailty on the mode of death in older patients with heart failure: a cohort study. Circ Cardiovasc Qual Outcomes 17(5):e010416PubMed Ohashi K, Matsue Y, Maeda D et al (2024) Impact of multidomain frailty on the mode of death in older patients with heart failure: a cohort study. Circ Cardiovasc Qual Outcomes 17(5):e010416PubMed
22.
go back to reference Beezer J, Al Hatrushi M, Husband A et al (2022) Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev 27:465–492PubMedCrossRef Beezer J, Al Hatrushi M, Husband A et al (2022) Polypharmacy definition and prevalence in heart failure: a systematic review. Heart Fail Rev 27:465–492PubMedCrossRef
23.
go back to reference McDonagh TA, Metra M, Adamo M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726PubMedCrossRef McDonagh TA, Metra M, Adamo M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726PubMedCrossRef
24.
go back to reference McDonagh TA, Metra M, Adamo M et al (2023) 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 28:ehad195 McDonagh TA, Metra M, Adamo M et al (2023) 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 28:ehad195
25.
go back to reference Khan MS, Samman Tahhan A, Vaduganathan M et al (2020) Trends in prevalence of comorbidities in heart failure clinical trials: comorbidities in HF clinical trials. Eur J Heart Fail 22:1032–1042PubMedCrossRef Khan MS, Samman Tahhan A, Vaduganathan M et al (2020) Trends in prevalence of comorbidities in heart failure clinical trials: comorbidities in HF clinical trials. Eur J Heart Fail 22:1032–1042PubMedCrossRef
26.
go back to reference Tersalvi G, Bossard M, Aeschbacher S et al (2024) Prevalence and outcomes of heart failure phenotypes in patients with atrial fibrillation. Int J Cardiol 412:132320PubMedCrossRef Tersalvi G, Bossard M, Aeschbacher S et al (2024) Prevalence and outcomes of heart failure phenotypes in patients with atrial fibrillation. Int J Cardiol 412:132320PubMedCrossRef
27.
go back to reference Verdiani V, Panigada G, Fortini A et al (2015) The heart failure in Internal Medicine in Tuscany: the SMIT Study. Ital J Med 9:349CrossRef Verdiani V, Panigada G, Fortini A et al (2015) The heart failure in Internal Medicine in Tuscany: the SMIT Study. Ital J Med 9:349CrossRef
28.
go back to reference Khan MS, Singh S, Segar MW et al (2023) Polypharmacy and optimization of guideline-directed medical therapy in heart failure. JACC Heart Fail 11:S2213177923001373CrossRef Khan MS, Singh S, Segar MW et al (2023) Polypharmacy and optimization of guideline-directed medical therapy in heart failure. JACC Heart Fail 11:S2213177923001373CrossRef
29.
go back to reference Cobretti MR, Page RL, Linnebur SA et al (2017) Medication regimen complexity in ambulatory older adults with heart failure. Clin Interv Aging 12:679–686PubMedPubMedCentralCrossRef Cobretti MR, Page RL, Linnebur SA et al (2017) Medication regimen complexity in ambulatory older adults with heart failure. Clin Interv Aging 12:679–686PubMedPubMedCentralCrossRef
30.
go back to reference Wimmer BC, Bell JS, Fastbom J et al (2016) Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: a population-based cohort study. Ann Pharmacother 50:89–95PubMedPubMedCentralCrossRef Wimmer BC, Bell JS, Fastbom J et al (2016) Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: a population-based cohort study. Ann Pharmacother 50:89–95PubMedPubMedCentralCrossRef
31.
go back to reference Veehof L, Stewart R, Haaijer-Ruskamp F et al (2000) The development of polypharmacy. A longitudinal study. Fam Pract 17:261–267PubMedCrossRef Veehof L, Stewart R, Haaijer-Ruskamp F et al (2000) The development of polypharmacy. A longitudinal study. Fam Pract 17:261–267PubMedCrossRef
32.
go back to reference Gnjidic D, Le Couteur DG, Pearson S-A et al (2013) High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level. BMC Public Health 13:115PubMedPubMedCentralCrossRef Gnjidic D, Le Couteur DG, Pearson S-A et al (2013) High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level. BMC Public Health 13:115PubMedPubMedCentralCrossRef
33.
go back to reference Halli-Tierney AD, Scarbrough C, Carroll D (2019) Polypharmacy: evaluating risks and deprescribing. Am Fam Physician 100(1):32–38PubMed Halli-Tierney AD, Scarbrough C, Carroll D (2019) Polypharmacy: evaluating risks and deprescribing. Am Fam Physician 100(1):32–38PubMed
34.
go back to reference Cussans A, Harvey G, Kemple T et al (2021) Interventions to reduce the environmental impact of medicines: a UK perspective✰. J Clim Change Health 4:100079CrossRef Cussans A, Harvey G, Kemple T et al (2021) Interventions to reduce the environmental impact of medicines: a UK perspective✰. J Clim Change Health 4:100079CrossRef
35.
go back to reference Foy AJ, Brown DL (2023) Importance of designing trials for older adults with complex medical conditions. JAMA Intern Med 183:415PubMedCrossRef Foy AJ, Brown DL (2023) Importance of designing trials for older adults with complex medical conditions. JAMA Intern Med 183:415PubMedCrossRef
37.
go back to reference Shah SJ, Van Walraven C, Jeon SY et al (2024) Estimating vitamin K antagonist anticoagulation benefit in people with atrial fibrillation accounting for competing risks: evidence from 12 randomized trials. Circ Cardiovasc Qual Outcomes 17:e010269PubMedCrossRef Shah SJ, Van Walraven C, Jeon SY et al (2024) Estimating vitamin K antagonist anticoagulation benefit in people with atrial fibrillation accounting for competing risks: evidence from 12 randomized trials. Circ Cardiovasc Qual Outcomes 17:e010269PubMedCrossRef
38.
go back to reference Warner V, Nguyen D, Bayles T et al (2022) Management of heart failure in older people. Pharm Pract Res 52:72–79CrossRef Warner V, Nguyen D, Bayles T et al (2022) Management of heart failure in older people. Pharm Pract Res 52:72–79CrossRef
39.
go back to reference Mebazaa A, Davison B, Chioncel O et al (2022) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet 400:1938–1952PubMedCrossRef Mebazaa A, Davison B, Chioncel O et al (2022) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial. Lancet 400:1938–1952PubMedCrossRef
40.
go back to reference Arrigo M, Biegus J, Asakage A et al (2023) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure in elderly patients: a sub-analysis of the STRONG-HF randomized clinical trial. Eur J Heart Fail 25:1145–1155PubMedCrossRef Arrigo M, Biegus J, Asakage A et al (2023) Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure in elderly patients: a sub-analysis of the STRONG-HF randomized clinical trial. Eur J Heart Fail 25:1145–1155PubMedCrossRef
41.
go back to reference Barry AR, Grewal M, Blain L (2023) Use of guideline-directed medical therapy in patients aged 80 years or older with heart failure with reduced ejection fraction. CJC Open 5:303–309PubMedPubMedCentralCrossRef Barry AR, Grewal M, Blain L (2023) Use of guideline-directed medical therapy in patients aged 80 years or older with heart failure with reduced ejection fraction. CJC Open 5:303–309PubMedPubMedCentralCrossRef
42.
go back to reference Stolfo D, Lund LH, Becher PM et al (2022) Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata. Eur J Heart Fail 24:1047–1062PubMedCrossRef Stolfo D, Lund LH, Becher PM et al (2022) Use of evidence-based therapy in heart failure with reduced ejection fraction across age strata. Eur J Heart Fail 24:1047–1062PubMedCrossRef
43.
go back to reference Veenis JF, Brunner-La Rocca H-P, Linssen GC et al (2019) Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction. Eur J Prev Cardiol 26:1399–1407PubMedPubMedCentralCrossRef Veenis JF, Brunner-La Rocca H-P, Linssen GC et al (2019) Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction. Eur J Prev Cardiol 26:1399–1407PubMedPubMedCentralCrossRef
44.
go back to reference Seo W-W, Park JJ, Park HA et al (2020) Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study. BMJ Open 10:e030514PubMedPubMedCentralCrossRef Seo W-W, Park JJ, Park HA et al (2020) Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study. BMJ Open 10:e030514PubMedPubMedCentralCrossRef
45.
go back to reference Goyal P, Zullo AR, Gladders B et al (2023) Real-world safety of neurohormonal antagonist initiation among older adults following a heart failure hospitalization. ESC Heart Fail 10:1623–1634PubMedPubMedCentralCrossRef Goyal P, Zullo AR, Gladders B et al (2023) Real-world safety of neurohormonal antagonist initiation among older adults following a heart failure hospitalization. ESC Heart Fail 10:1623–1634PubMedPubMedCentralCrossRef
46.
go back to reference Rothwell PM (2005) Treating individuals 2. Subgroup analysis in randomised controlled trials: importance, indications, and interpretation. Lancet 365:176–186PubMedCrossRef Rothwell PM (2005) Treating individuals 2. Subgroup analysis in randomised controlled trials: importance, indications, and interpretation. Lancet 365:176–186PubMedCrossRef
47.
go back to reference Flather MD, Shibata MC, Coats AJS et al (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225PubMedCrossRef Flather MD, Shibata MC, Coats AJS et al (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225PubMedCrossRef
48.
go back to reference Kotecha D, Holmes J, Krum H et al (2014) Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 384:2235–2243PubMedCrossRef Kotecha D, Holmes J, Krum H et al (2014) Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 384:2235–2243PubMedCrossRef
49.
go back to reference Molnar AO, Petrcich W, Weir MA et al (2020) The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease. Nephrol Dial Transpl 35:782–789CrossRef Molnar AO, Petrcich W, Weir MA et al (2020) The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease. Nephrol Dial Transpl 35:782–789CrossRef
50.
go back to reference Kotecha D, Gill SK, Flather MD et al (2019) Impact of renal impairment on beta-blocker efficacy in patients with heart failure. J Am Coll Cardiol 74:2893–2904PubMedCrossRef Kotecha D, Gill SK, Flather MD et al (2019) Impact of renal impairment on beta-blocker efficacy in patients with heart failure. J Am Coll Cardiol 74:2893–2904PubMedCrossRef
51.
go back to reference Palau P, Seller J, Domínguez E et al (2021) Effect of β-blocker withdrawal on functional capacity in heart failure and preserved ejection fraction. J Am Coll Cardiol 78:2042–2056PubMedCrossRef Palau P, Seller J, Domínguez E et al (2021) Effect of β-blocker withdrawal on functional capacity in heart failure and preserved ejection fraction. J Am Coll Cardiol 78:2042–2056PubMedCrossRef
52.
go back to reference Flather MD, Yusuf S, Køber L et al (2000) Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 355:1575–1581PubMedCrossRef Flather MD, Yusuf S, Køber L et al (2000) Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 355:1575–1581PubMedCrossRef
53.
go back to reference Dickstein K, Kjekshus J (2002) Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 360:752–760PubMedCrossRef Dickstein K, Kjekshus J (2002) Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 360:752–760PubMedCrossRef
54.
go back to reference Pitt B, Poole-Wilson PA, Segal R et al (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 355:1582–1587PubMedCrossRef Pitt B, Poole-Wilson PA, Segal R et al (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet 355:1582–1587PubMedCrossRef
55.
go back to reference Heran BS, Musini VM, Bassett K et al (2012) Angiotensin receptor blockers for heart failure. Cochrane Database Syst Rev 2012:CD003040PubMedPubMedCentral Heran BS, Musini VM, Bassett K et al (2012) Angiotensin receptor blockers for heart failure. Cochrane Database Syst Rev 2012:CD003040PubMedPubMedCentral
56.
go back to reference Jhund PS, Fu M, Bayram E et al (2015) Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J 36:2576–2584PubMedPubMedCentralCrossRef Jhund PS, Fu M, Bayram E et al (2015) Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J 36:2576–2584PubMedPubMedCentralCrossRef
57.
go back to reference Gatti M, Antonazzo IC, Diemberger I et al (2021) Adverse events with sacubitril/valsartan in the real world: emerging signals to target preventive strategies from the FDA adverse event reporting system. Eur J Prev Cardiol 28:983–989PubMedCrossRef Gatti M, Antonazzo IC, Diemberger I et al (2021) Adverse events with sacubitril/valsartan in the real world: emerging signals to target preventive strategies from the FDA adverse event reporting system. Eur J Prev Cardiol 28:983–989PubMedCrossRef
58.
go back to reference Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341:709–717PubMedCrossRef Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341:709–717PubMedCrossRef
59.
go back to reference Zannad F, McMurray JJV, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21PubMedCrossRef Zannad F, McMurray JJV, Krum H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364:11–21PubMedCrossRef
60.
go back to reference Solomon SD, McMurray JJV, Vaduganathan M et al (2024) Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med:NEJMoa2407107 Solomon SD, McMurray JJV, Vaduganathan M et al (2024) Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med:NEJMoa2407107
61.
go back to reference Ferreira JP, Rossello X, Eschalier R et al (2019) MRAs in elderly HF patients. JACC Heart Fail 7:1012–1021PubMedCrossRef Ferreira JP, Rossello X, Eschalier R et al (2019) MRAs in elderly HF patients. JACC Heart Fail 7:1012–1021PubMedCrossRef
62.
go back to reference Solomon SD, Claggett B, Lewis EF et al (2016) Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 37:455–462PubMedCrossRef Solomon SD, Claggett B, Lewis EF et al (2016) Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J 37:455–462PubMedCrossRef
63.
go back to reference Beldhuis IE, Myhre PL, Claggett B et al (2019) Efficacy and safety of spironolactone in patients with HFpEF and chronic kidney disease. JACC Heart Fail 7:25–32PubMedCrossRef Beldhuis IE, Myhre PL, Claggett B et al (2019) Efficacy and safety of spironolactone in patients with HFpEF and chronic kidney disease. JACC Heart Fail 7:25–32PubMedCrossRef
64.
go back to reference Savarese G, Carrero J, Pitt B et al (2018) Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry. Eur J Heart Fail 20:1326–1334PubMedCrossRef Savarese G, Carrero J, Pitt B et al (2018) Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry. Eur J Heart Fail 20:1326–1334PubMedCrossRef
65.
go back to reference Jonsson Holmdahl A, Wessberg G, Norberg H et al (2022) Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population. Open Heart 9:e002022PubMedPubMedCentralCrossRef Jonsson Holmdahl A, Wessberg G, Norberg H et al (2022) Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population. Open Heart 9:e002022PubMedPubMedCentralCrossRef
66.
go back to reference Larsson JE, Denholt CS, Thune JJ et al (2023) Initiation of eplerenone or spironolactone, treatment adherence, and associated outcomes in patients with new-onset heart failure with reduced ejection fraction: a nationwide cohort study. Eur Heart J Cardiovasc Pharmacother 9:546–552PubMedCrossRef Larsson JE, Denholt CS, Thune JJ et al (2023) Initiation of eplerenone or spironolactone, treatment adherence, and associated outcomes in patients with new-onset heart failure with reduced ejection fraction: a nationwide cohort study. Eur Heart J Cardiovasc Pharmacother 9:546–552PubMedCrossRef
67.
go back to reference Martinez FA, Serenelli M, Nicolau JC et al (2020) Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF. Circulation 141:100–111PubMedCrossRef Martinez FA, Serenelli M, Nicolau JC et al (2020) Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF. Circulation 141:100–111PubMedCrossRef
68.
go back to reference Filippatos G, Anker SD, Butler J et al (2022) Effects of empagliflozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: a secondary analysis of EMPEROR-Reduced. Eur J Heart Fail 24:2297–2304PubMedCrossRef Filippatos G, Anker SD, Butler J et al (2022) Effects of empagliflozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: a secondary analysis of EMPEROR-Reduced. Eur J Heart Fail 24:2297–2304PubMedCrossRef
69.
go back to reference Solomon SD, McMurray JJV, Claggett B et al (2022) Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 387:1089–1098PubMedCrossRef Solomon SD, McMurray JJV, Claggett B et al (2022) Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 387:1089–1098PubMedCrossRef
70.
go back to reference Anker SD, Butler J, Filippatos G et al (2021) Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 385:1451–1461PubMedCrossRef Anker SD, Butler J, Filippatos G et al (2021) Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 385:1451–1461PubMedCrossRef
71.
go back to reference Liu Y, An C, Liu P et al (2023) Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis. Ren Fail 45:2217287PubMedPubMedCentralCrossRef Liu Y, An C, Liu P et al (2023) Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis. Ren Fail 45:2217287PubMedPubMedCentralCrossRef
73.
go back to reference Böhm M, Butler J, Filippatos G et al (2022) Empagliflozin improves outcomes in patients with heart failure and preserved ejection fraction irrespective of age. J Am Coll Cardiol 80:1–18PubMedCrossRef Böhm M, Butler J, Filippatos G et al (2022) Empagliflozin improves outcomes in patients with heart failure and preserved ejection fraction irrespective of age. J Am Coll Cardiol 80:1–18PubMedCrossRef
74.
go back to reference Butt JH, Jhund PS, Belohlávek J et al (2022) Efficacy and safety of dapagliflozin according to frailty in patients with heart failure: a prespecified analysis of the DELIVER trial. Circulation 146:1210–1224PubMedPubMedCentralCrossRef Butt JH, Jhund PS, Belohlávek J et al (2022) Efficacy and safety of dapagliflozin according to frailty in patients with heart failure: a prespecified analysis of the DELIVER trial. Circulation 146:1210–1224PubMedPubMedCentralCrossRef
75.
go back to reference Butt JH, Dewan P, Merkely B et al (2022) Efficacy and safety of dapagliflozin according to frailty in heart failure with reduced ejection fraction: a post hoc analysis of the DAPA-HF trial. Ann Intern Med 175:820–830PubMedCrossRef Butt JH, Dewan P, Merkely B et al (2022) Efficacy and safety of dapagliflozin according to frailty in heart failure with reduced ejection fraction: a post hoc analysis of the DAPA-HF trial. Ann Intern Med 175:820–830PubMedCrossRef
76.
go back to reference Hias J, Hellemans L, Walgraeve K et al (2022) SGLT2 inhibitors in older adults with heart failure with preserved ejection fraction. Drugs Aging 39:185–190PubMedCrossRef Hias J, Hellemans L, Walgraeve K et al (2022) SGLT2 inhibitors in older adults with heart failure with preserved ejection fraction. Drugs Aging 39:185–190PubMedCrossRef
77.
go back to reference Seferović PM, Fragasso G, Petrie M et al (2020) Sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 22:1495–1503PubMedCrossRef Seferović PM, Fragasso G, Petrie M et al (2020) Sodium-glucose co-transporter 2 inhibitors in heart failure: beyond glycaemic control. A position paper of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 22:1495–1503PubMedCrossRef
78.
go back to reference Qiu M, Ding L-L, Zhang M et al (2021) Safety of four SGLT2 inhibitors in three chronic diseases: a meta-analysis of large randomized trials of SGLT2 inhibitors. Diab Vasc Dis Res 18:14791641211011016PubMedPubMedCentralCrossRef Qiu M, Ding L-L, Zhang M et al (2021) Safety of four SGLT2 inhibitors in three chronic diseases: a meta-analysis of large randomized trials of SGLT2 inhibitors. Diab Vasc Dis Res 18:14791641211011016PubMedPubMedCentralCrossRef
79.
go back to reference Pollack R, Cahn A (2022) SGLT2 inhibitors and safety in older patients. Heart Fail Clin 18:635–643PubMedCrossRef Pollack R, Cahn A (2022) SGLT2 inhibitors and safety in older patients. Heart Fail Clin 18:635–643PubMedCrossRef
80.
go back to reference Jansen S, Bhangu J, De Rooij S et al (2016) The association of cardiovascular disorders and falls: a systematic review. J Am Med Dir Assoc 17:193–199PubMedCrossRef Jansen S, Bhangu J, De Rooij S et al (2016) The association of cardiovascular disorders and falls: a systematic review. J Am Med Dir Assoc 17:193–199PubMedCrossRef
81.
go back to reference Goyal P, Anderson TS, Bernacki GM et al (2020) Physician perspectives on deprescribing cardiovascular medications for older adults. J Am Geriatr Soc 68:78–86PubMedCrossRef Goyal P, Anderson TS, Bernacki GM et al (2020) Physician perspectives on deprescribing cardiovascular medications for older adults. J Am Geriatr Soc 68:78–86PubMedCrossRef
82.
go back to reference Montero-Odasso M, Van Der Velde N, Martin FC et al (2022) World guidelines for falls prevention and management for older adults: a global initiative. Age Age 51:afac205CrossRef Montero-Odasso M, Van Der Velde N, Martin FC et al (2022) World guidelines for falls prevention and management for older adults: a global initiative. Age Age 51:afac205CrossRef
83.
go back to reference Scott IA, Hilmer SN, Reeve E et al (2015) Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 175:827–834PubMedCrossRef Scott IA, Hilmer SN, Reeve E et al (2015) Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 175:827–834PubMedCrossRef
84.
go back to reference By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel (2023) American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 71:2052–2081CrossRef By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel (2023) American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 71:2052–2081CrossRef
85.
go back to reference O’Mahony D, Gallagher P, Ryan C et al (2010) STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med 1:45–51CrossRef O’Mahony D, Gallagher P, Ryan C et al (2010) STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med 1:45–51CrossRef
86.
go back to reference Zhou D, Chen Z, Tian F (2023) Deprescribing interventions for older patients: a systematic review and meta-analysis. J Am Med Direct Assoc 24:S152586102300645XCrossRef Zhou D, Chen Z, Tian F (2023) Deprescribing interventions for older patients: a systematic review and meta-analysis. J Am Med Direct Assoc 24:S152586102300645XCrossRef
87.
go back to reference Martin P, Tamblyn R, Benedetti A et al (2018) Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. JAMA 320:1889PubMedPubMedCentralCrossRef Martin P, Tamblyn R, Benedetti A et al (2018) Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. JAMA 320:1889PubMedPubMedCentralCrossRef
88.
go back to reference Vasilevskis EE, Shah AS, Hollingsworth EK et al (2023) Deprescribing medications among older adults from end of hospitalization through postacute care: a shed-meds randomized clinical trial. JAMA Intern Med 183:223PubMedPubMedCentralCrossRef Vasilevskis EE, Shah AS, Hollingsworth EK et al (2023) Deprescribing medications among older adults from end of hospitalization through postacute care: a shed-meds randomized clinical trial. JAMA Intern Med 183:223PubMedPubMedCentralCrossRef
89.
go back to reference Herrinton LJ, Lo K, Alavi M et al (2023) Effectiveness of bundled hyperpolypharmacy deprescribing compared with usual care among older adults: a randomized clinical trial. JAMA Netw Open 6:e2322505PubMedPubMedCentralCrossRef Herrinton LJ, Lo K, Alavi M et al (2023) Effectiveness of bundled hyperpolypharmacy deprescribing compared with usual care among older adults: a randomized clinical trial. JAMA Netw Open 6:e2322505PubMedPubMedCentralCrossRef
90.
go back to reference McDonald EG, Wu PE, Rashidi B et al (2022) The MedSafer study—electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. JAMA Intern Med 182:265PubMedCrossRef McDonald EG, Wu PE, Rashidi B et al (2022) The MedSafer study—electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. JAMA Intern Med 182:265PubMedCrossRef
91.
go back to reference Ibrahim K, Cox NJ, Stevenson JM et al (2021) A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21:258PubMedPubMedCentralCrossRef Ibrahim K, Cox NJ, Stevenson JM et al (2021) A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21:258PubMedPubMedCentralCrossRef
92.
go back to reference Navid P, Nguyen L, Jaber D et al (2021) Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 69:1948–1955PubMedPubMedCentralCrossRef Navid P, Nguyen L, Jaber D et al (2021) Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 69:1948–1955PubMedPubMedCentralCrossRef
93.
go back to reference Beezer J, Roe L, Husband A (2022) A retrospective cohort review of prescribing in hospitalised patients with heart failure using Beers criteria and STOPP recommendations. Pharm Pract Res 52:132–138CrossRef Beezer J, Roe L, Husband A (2022) A retrospective cohort review of prescribing in hospitalised patients with heart failure using Beers criteria and STOPP recommendations. Pharm Pract Res 52:132–138CrossRef
94.
go back to reference Punnoose LR, Givertz MM, Lewis EF et al (2011) Heart failure with recovered ejection fraction: a distinct clinical entity. J Cardiac Fail 17:527–532CrossRef Punnoose LR, Givertz MM, Lewis EF et al (2011) Heart failure with recovered ejection fraction: a distinct clinical entity. J Cardiac Fail 17:527–532CrossRef
95.
go back to reference Hopper I, Samuel R, Hayward C et al (2014) Can medications be safely withdrawn in patients with stable chronic heart failure? Systematic review and meta-analysis. J Cardiac Fail 20:522–532CrossRef Hopper I, Samuel R, Hayward C et al (2014) Can medications be safely withdrawn in patients with stable chronic heart failure? Systematic review and meta-analysis. J Cardiac Fail 20:522–532CrossRef
96.
go back to reference Rossello X, Pocock SJ, Julian DG (2015) Long-term use of cardiovascular drugs. J Am Coll Cardiol 66:1273–1285PubMedCrossRef Rossello X, Pocock SJ, Julian DG (2015) Long-term use of cardiovascular drugs. J Am Coll Cardiol 66:1273–1285PubMedCrossRef
97.
go back to reference Bursi F, Weston SA, Redfield MM et al (2006) Systolic and diastolic heart failure in the community. JAMA 296:2209–2216PubMedCrossRef Bursi F, Weston SA, Redfield MM et al (2006) Systolic and diastolic heart failure in the community. JAMA 296:2209–2216PubMedCrossRef
98.
go back to reference Redfield MM, Borlaug BA (2023) Heart failure with preserved ejection fraction: a review. JAMA 329:827PubMedCrossRef Redfield MM, Borlaug BA (2023) Heart failure with preserved ejection fraction: a review. JAMA 329:827PubMedCrossRef
99.
go back to reference McDonagh TA, Blue L, Clark AL et al (2011) European society of cardiology heart failure association standards for delivering heart failure care. Eur J Heart Fail 13:235–241PubMedCrossRef McDonagh TA, Blue L, Clark AL et al (2011) European society of cardiology heart failure association standards for delivering heart failure care. Eur J Heart Fail 13:235–241PubMedCrossRef
100.
go back to reference Adler ED, Goldfinger JZ, Kalman J et al (2009) Palliative care in the treatment of advanced heart failure. Circulation 120:2597–2606PubMedCrossRef Adler ED, Goldfinger JZ, Kalman J et al (2009) Palliative care in the treatment of advanced heart failure. Circulation 120:2597–2606PubMedCrossRef
101.
go back to reference Schuling J, Gebben H, Veehof LJG et al (2012) Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract 13:56PubMedPubMedCentralCrossRef Schuling J, Gebben H, Veehof LJG et al (2012) Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract 13:56PubMedPubMedCentralCrossRef
102.
go back to reference Milfred-LaForest SK, Chow SL, DiDomenico RJ et al (2013) Clinical pharmacy services in heart failure: an opinion paper from the heart failure society of America and American College of Clinical Pharmacy Cardiology practice and research network. J Cardiac Fail 19:354–369CrossRef Milfred-LaForest SK, Chow SL, DiDomenico RJ et al (2013) Clinical pharmacy services in heart failure: an opinion paper from the heart failure society of America and American College of Clinical Pharmacy Cardiology practice and research network. J Cardiac Fail 19:354–369CrossRef
104.
go back to reference Kutner JS, Blatchford PJ, Taylor DH et al (2015) Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 175:691PubMedPubMedCentralCrossRef Kutner JS, Blatchford PJ, Taylor DH et al (2015) Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 175:691PubMedPubMedCentralCrossRef
105.
go back to reference Van Poelgeest EP, Handoko ML, Muller M et al (2023) Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review. Eur Geriatr Med 14:659–674PubMedPubMedCentralCrossRef Van Poelgeest EP, Handoko ML, Muller M et al (2023) Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review. Eur Geriatr Med 14:659–674PubMedPubMedCentralCrossRef
106.
go back to reference Martens P, Verbrugge FH, Boonen L et al (2018) Value of routine investigations to predict loop diuretic down-titration success in stable heart failure. Int J Cardiol 250:171–175PubMedCrossRef Martens P, Verbrugge FH, Boonen L et al (2018) Value of routine investigations to predict loop diuretic down-titration success in stable heart failure. Int J Cardiol 250:171–175PubMedCrossRef
107.
go back to reference Damman K, Masson S, Lucci D et al (2017) Progression of renal impairment and chronic kidney disease in chronic heart failure: an analysis from GISSI-HF. J Card Fail 23:2–9PubMedCrossRef Damman K, Masson S, Lucci D et al (2017) Progression of renal impairment and chronic kidney disease in chronic heart failure: an analysis from GISSI-HF. J Card Fail 23:2–9PubMedCrossRef
Metadata
Title
Deprescribing strategies in older patients with heart failure
Authors
Gregorio Tersalvi
Vittorio Beltrani
Marco Peronti
Ludovico Furlan
Andrew Foy
Luigi Biasco
Publication date
15-10-2024

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
 

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Register your interest now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

Keynote webinar | Spotlight on medication adherence

  • Webinar | 27-06-2024 | 18:00 (CEST)

Medication non-adherence is a major barrier to effective healthcare delivery; half of all patients do not follow their doctor’s recommendations or treatment plan.

Our experts explain the fundamentals with a practical discussion of how to manage non-adherence in two common scenarios: hypertension and asthma control.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Watch now