When cardiovascular medicines should be discontinued.

Autor: Krychtiuk KA; Duke Clinical Research Institute, 300 W Morgan Street, Durham, NC 27701, USA.; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria., Gersh BJ; Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA., Washam JB; Division of Clinical Pharmacology, Department of Medicine, Duke University, Durham, NC, USA., Granger CB; Duke Clinical Research Institute, 300 W Morgan Street, Durham, NC 27701, USA.
Jazyk: angličtina
Zdroj: European heart journal [Eur Heart J] 2024 Jun 14; Vol. 45 (23), pp. 2039-2051.
DOI: 10.1093/eurheartj/ehae302
Abstrakt: An integral component of the practice of medicine is focused on the initiation of medications, based on clinical practice guidelines and underlying trial evidence, which usually test the addition of novel medications intended for life-long use in short-term clinical trials. Much less attention is given to the question of medication discontinuation, especially after a lengthy period of treatment, during which patients age gets older and diseases may either progress or new diseases may emerge. Given the paucity of data, clinical practice guidelines offer little to no guidance on when and how to deprescribe cardiovascular medications. Such decisions are often left to the discretion of clinicians, who, together with their patients, express concern of potential adverse effects of medication discontinuation. Even in the absence of adverse effects, the continuation of medications without any proven effect may cause harm due to drug-drug interactions, the emergence of polypharmacy, and additional preventable spending to already strained health systems. Herein, several cardiovascular medications or medication classes are discussed that in the opinion of this author group should generally be discontinued, either for the prevention of potential harm, for a lack of benefit, or for the availability of better alternatives.
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Databáze: MEDLINE