Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications

• Published in: Drugs & aging Vol. 37; no. 2; pp. 125 - 135
• Main Authors: Goyal, Parag, Requijo, Tatiana, Siceloff, Birgit, Shen, Megan J., Masterson Creber, Ruth, Hilmer, Sarah N., Kronish, Ian M., Lachs, Mark S., Safford, Monika M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2020; Springer Nature B.V
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Aged; Cardiovascular Agents - administration & dosage; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Chronic illnesses; Clinical practice guidelines; Deprescriptions; Ejection fraction; Female; Geriatrics/Gerontology; Heart failure; Heart Failure - drug therapy; Hospitalization; Humans; Internal Medicine; Life expectancy; Male; Medicine; Medicine & Public Health; Older people; Original Research Article; Patient education; Patient Reported Outcome Measures; Patient Safety; Patient satisfaction; Pharmacology/Toxicology; Pharmacotherapy; Polypharmacy; Psychotropic drugs; Surveys and Questionnaires; Systematic review
• ISSN: 1170-229X; 1179-1969
• DOI: 10.1007/s40266-019-00729-x

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.