Title | |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Goyal P, Requijo T, Siceloff B, Shen MJ, Creber RMasterson, Hilmer SN, Kronish IM, Lachs MS, Safford MM |
Journal | Drugs Aging |
Volume | 37 |
Issue | 2 |
Pagination | 125-135 |
Date Published | 2020 02 |
ISSN | 1179-1969 |
Keywords | Adrenergic beta-Antagonists, Aged, Cardiovascular Agents, Deprescriptions, Female, Heart Failure, Hospitalization, Humans, Male, Patient Reported Outcome Measures, Patient Safety, Surveys and Questionnaires |
Abstract | BACKGROUND: Medications endorsed by clinical practice guidelines, such as cardiovascular medications, could still have risks that outweigh potential benefits, and could thus warrant deprescribing. OBJECTIVES: The objective of this study was to develop a framework of facilitators and barriers specific to deprescribing cardiovascular medications in the setting of uncertain benefit. Given the frequent use of β-blockers in heart failure with preserved ejection fraction, and its uncertain benefits with potential for harm, we used this scenario as an example case for a cardiovascular medication that may be reasonable to deprescribe. METHODS: We conducted one-on-one, semi-structured interviews of older adults until we reached thematic saturation. Two coders independently reviewed each interview, and developed codes using deductive thematic analysis based on a prior conceptual framework for deprescribing. Subthemes and themes were finalized with a third coder. RESULTS: Ten participants were interviewed. We identified three key previously described patient-reported facilitators to deprescribing: (1) appropriateness of cessation; (2) process of cessation; and (3) dislike of medications; and identified three key previously described patient-reported barriers: (1) appropriateness of cessation; (2) process of cessation; and (3) fear. We found that these facilitators and barriers often co-occurred within the same individual. This observation, coupled with subthemes from our patient interviews, yielded two barriers to deprescribing specific to cardiovascular medications-uncertainty and conflicting attitudes. CONCLUSION: We adapted a new framework of patient-reported barriers and facilitators specific to deprescribing cardiovascular medications. In addition to addressing barriers previously described, future deprescribing interventions targeting cardiovascular medications must also address uncertainty and conflicting attitudes. |
DOI | 10.1007/s40266-019-00729-x |
Alternate Journal | Drugs Aging |
PubMed ID | 31858449 |
PubMed Central ID | PMC7339041 |
Grant List | L30 AG060521 / AG / NIA NIH HHS / United States R00 NR016275 / NR / NINR NIH HHS / United States R03 AG056446 / AG / NIA NIH HHS / United States K07 CA207580 / CA / NCI NIH HHS / United States |