Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications

Goyal, Parag; Requijo, Tatiana; Siceloff, Birgit; Shen, Megan Johnson; Creber, Ruth Masterson; Hilmer, Sarah N.; Kronish, Ian M.; Lachs, Mark S.; Safford, Monika M.

doi:10.1007/s40266-019-00729-x

Cited by 28 publications

(74 citation statements)

References 72 publications

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“…Across the three participant groups, the majority was satisfied with their current medications; however, participants also expressed great interest in deprescribing. Such conflicting attitudes have been extensively reported in the qualitative literature, where older people would like to reduce their number of medications but at the same time feel obliged to take them 24,25,28‐30 …”

Section: Discussionmentioning

confidence: 99%

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Lundby

Glans

Simonsen

et al. 2021

J American Geriatrics Society

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Background/Objectives Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. Design Interview‐based questionnaire study. Setting Denmark. Participants Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation‐Memory‐Concentration score of ≥8. Measurements Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. Results Participants had a median age of 82 years (interquartile range [IQR] 76–89) and used a median of 8 medications (IQR 5–10). Thirty‐three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden” score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median “involvement” score 80 vs 75, p < 0.05) and geriatric inpatients (median “involvement” score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased “burden” score (ptrend = 0.001): Those using 1–4 medications daily had a median score of 25 (IQR 17–33) compared to 58 (IQR 42–75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping” score (ptrend = 0.001) and a lower "appropriateness” score (ptrend < 0.001), respectively. Conclusion Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

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Section: Discussionmentioning

confidence: 99%

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Lundby

Glans

Simonsen

et al. 2021

J American Geriatrics Society

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“…Furthermore, patients do not always see the need to stop medication they have been taking for a long time and medication they experience no harm from [ 32 , 40 ]. For cardiometabolic medication in particular, confusion about changing treatment targets, uncertainty about the risks and benefits, and inconsistent feelings towards deprescribing were identified as barriers [ 43 , 44 ].…”

Section: Introductionmentioning

confidence: 99%

Older people’s attitudes towards deprescribing cardiometabolic medication

et al. 2021

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Background Overtreatment with cardiometabolic medication in older patients can lead to major adverse events. Timely deprescribing of these medications is therefore essential. Self-reported willingness to stop medication is usually high among older people, still overtreatment with cardiometabolic medication is common and deprescribing is rarely initiated. An important barrier for deprescribing reported by general practitioners is the patients’ unwillingness to stop the medication. More insights are needed into the influence of patients’ characteristics on their attitudes towards deprescribing and differences in these attitudes between cardiometabolic medication groups. Methods A survey in older people using cardiometabolic medication using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire was performed. Participants completed the general rPATD and an adapted version for four medication groups. Linear and ordinal logistic regression were used to assess the influence of age, sex, therapeutic area and number of medications used on the patients’ general attitudes towards deprescribing. Univariate analysis was used to compare differences in deprescribing attitudes towards sulfonylureas, insulins, antihypertensive medication and statins. Results Overall, 314 out of 1143 invited participants completed the survey (median age 76 years, 54% female). Most participants (80%) were satisfied with their medication and willing to stop medications if their doctor said it was possible (88%). Age, sex and therapeutic area had no influence on the general attitudes towards deprescribing. Taking more than ten medicines was significantly associated with a higher perceived medication burden. Antihypertensive medication and insulin were considered more appropriate than statins, and insulin was considered more appropriate than sulfonylureas not favouring deprescribing. Conclusions The majority of older people using cardiometabolic medication are willing to stop one of their medicines if their doctor said it was possible. Health care providers should take into account that patients perceive some of their medication as more appropriate than other medication when discussing deprescribing.

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“…This observation adds to a growing body of literature showing that patients often have mixed feelings about deprescribing. For example, in a study of patients with HFpEF, participants reported that they did not like taking so many medications, but they were uncomfortable with stopping them 7 . Contributors to these inconsistencies are not yet fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, polypharmacy and complex medication regimens are nearly universal in HFpEF 4,5 ; and conditions that impact the risk–benefit ratio of many medications, such as frailty and cognitive impairment, are highly prevalent 6 . Given these vulnerabilities, adults with HFpEF have emerged as an important population for deprescribing efforts 7 …”

Section: Introductionmentioning

confidence: 99%

Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction

Navid

Nguyen

Jaber

et al. 2021

J American Geriatrics Society

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Background/Objectives Attitudes toward deprescribing could vary among subpopulations. We sought to understand patient attitudes toward deprescribing among patients with heart failure with preserved ejection fraction (HFpEF). Design Retrospective cohort study. Setting Academic medical center in New York City. Participants Consecutive patients with HFpEF seen in July 2018–December 2019 at a program dedicated to providing care to older adults with HFpEF. Measurements We assessed the prevalence of vulnerabilities outlined in the domain management approach for caring for patients with heart failure and examined data on patient attitudes toward having their medicines deprescribed via the revised Patient Attitudes Toward Deprescribing (rPATD). Results Among 134 patients with HFpEF, median age was 75 (interquartile range 69–82), 60.4% were women, and 35.8% were nonwhite. Almost all patients had polypharmacy (94.0%) and 56.0% had hyperpolypharmacy; multimorbidity (80.6%) and frailty (78.7%) were also common. Overall, 90.3% reported that they would be willing to have one or more of their medicines deprescribed if told it was possible by their doctors; and 26.9% reported that they would like to try stopping one of their medicines to see how they feel without it. Notably, 91.8% of patients reported that they would like to be involved in decisions about their medicines. In bivariate logistic regression, nonwhite participants were less likely to want to try stopping one of their medicines to see how they feel without it (odds ratio 0.25, 95% confidence interval [0.09–0.62], p = 0.005). Conclusions Patients with HFpEF contend with many vulnerabilities that could prompt consideration for deprescribing. Most patients with HFpEF were amenable to deprescribing. Race may be an important factor that impacts patient attitudes toward deprescribing.

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Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications

Cited by 28 publications

References 72 publications

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Older people’s attitudes towards deprescribing cardiometabolic medication

Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction

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