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

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.

Development and acceptance of a new adherence monitoring package to identify non-adherent patients with polypharmacy in primary care: a feasibility study

“…Appropriate adjustments can include tackling polypharmacy by means of for example single-pill combinations or deprescribing of unnecessary or inappropriate medicines (to reduce the daily pill burden and to increase adherence to essential medicines). 11 25 Synchronising intake times with the patients' daily routine is a further possible adjustment Open access option. In addition, interventions to improve adherence should be selected in a shared decision-making process with the patient.…”

Polypharmacy Patterns in Multimorbid Older People with Cardiovascular Disease: Longitudinal Study

“…The high mortality observed in the Mental , behavioural , digestive and cerebrovascular pattern may be due to patients’ older age and greater multimorbidity and polypharmacy. These factors are interrelated, but also independently increase medication-related problems, worsen health outcomes, and increase mortality [ 6 , 9 , 10 , 40 ]. The results obtained can be interpreted in different ways.…”

“…CVD is associated with multimorbidity that leads to polypharmacy (that is, actively using five or more prescription drugs), especially in people over 65 years of age, who are also more susceptible to drug-related safety problems [ 5 , 6 , 7 ]. The increased use of medication has an impact on medication-related outcomes [ 8 ] as well as on morbidity, hospitalizations, mortality, and health system expenditure [ 6 , 9 , 10 , 11 ]. In addition, the pharmacokinetics and pharmacodynamics of drugs are different in older compared to younger adults due to the accumulation of cellular and molecular damage, which can make organs such as the kidneys, liver, heart, or lungs more vulnerable [ 12 , 13 ].…”

“…Although there are some clinical practice guidelines with recommendations on multimorbidity and polypharmacy, they do not consider the previous medication prescribed over time and how it can influence patient management [ 10 , 25 , 27 ]. Knowing how diseases cluster in this population and the specific medications that are used continuously and together can contribute to better health care.…”

Multimedikation

“…Es muss im Hinblick auf die Aktivitäten indikationsspezifischer Fachgesellschaften auch anerkannt werden, dass die zugrunde liegende Problematik erkannt wird: So hat die European Society for Cardiology durch ihre Working Group on Cardiovascular Pharmacotherapy kürzlich in einer Übersichtsarbeit analysiert, wie den Herausforderungen begegnet werden kann, vor denen Angehörige der Gesundheitsberufe stehen, wenn sie älteren Menschen mit kardiovaskulären Erkrankungen und Multimorbidität Medikamente verschreiben. Die Arbeit hält auch Informationen bereit, die das Thema Priorisierung ansprechen (Tamargo et al 2022).…”