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| European heart journal. Cardiovascular pharmacotherapy. 2022 Jan 29. pii: 6517311. doi: 10.1093/ehjcvp/pvac005 |
| Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. |
| Tamargo J1, Kjeldsen KP2, Delpón E3, Semb AG4, Cerbai E5, Dobrev D6, Savarese G7, Sulzgruber P8, Rosano G9, Borghi C10, Wassman S11, Torp-Pedersen CT12, Agewall S13, Drexel H14, Baumgartner I15, Lewis BS16, Ceconi C17, Kaski JC18, Niessner A19 |
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Abstract Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVD) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug-interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently under-represented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity and polypharmacy. Our goal is to provide information that can contribute to improve drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes. |
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© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. |
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KEYWORDS: adverse drug reactions, drug-drug and drug-disease interactions, inappropriate prescribing, older people, pharmacokinetic and pharmacodynamic changes, polypharmacy |
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Publikations ID: 35092425 Quelle: öffnen |
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