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
Year: 2022
Type: review
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 (CVDs) 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 underrepresented/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 improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
Authors: Juan Tamargo, Keld Per Kjeldsen, Eva Delpón, Anne Grete Semb, Elisabetta Cerbai, Dobromir Dobrev, Gianluigi Savarese, Patrick Sulzgruber, Giuseppe Rosano, Claudio Borghi, Sven Wassmann, Christian Tobias Torp-Pedersen, Stefan Agewall, Heinz Drexel, Iris Baumgartner, Basil Lewis, Claudio Ceconi, Juan Carlos Kaski, Alexander Niessner
Institutions: Universidad Complutense de Madrid, Amager Hospital, Copenhagen University Hospital, Aalborg University, Diakonhjemmet Hospital, University of Florence, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Karolinska University Hospital, Karolinska Institutet, Medical University of Vienna, Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS San Raffaele Roma, University of Bologna, Saarland University, University of Copenhagen, Nordsjællands Hospital, Oslo University Hospital, Landeskrankenhaus Feldkirch, Vorarlberg Institute for Vascular Investigation and Treatment, University Hospital of Bern, Technion – Israel Institute of Technology, Carmel Medical Center, Azienda Socio Sanitaria Territoriale del Garda, St George's, University of London
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4210669551