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Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications

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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.

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Authors and Affiliations

  1. Division of Cardiology/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA

    Parag Goyal & Birgit Siceloff

  2. Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY, 10063, USA

    Parag Goyal, Birgit Siceloff & Monika M. Safford

  3. School of Medicine, Weill Cornell Medicine, New York, NY, USA

    Tatiana Requijo

  4. Division of Geriatrics/Department of Medicine, Weill Cornell Medicine, New York, NY, USA

    Megan J. Shen & Mark S. Lachs

  5. Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA

    Ruth Masterson Creber

  6. Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, NSW, Australia

    Sarah N. Hilmer

  7. Sydney Medical School and Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    Sarah N. Hilmer

  8. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA

    Ian M. Kronish

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  1. Parag Goyal
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Contributions

All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Dr. Goyal had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: PG, TR, MMS. Acquisition, analysis, or interpretation of data: PG, TR, BS, RMC, SNH. Drafting of the manuscript: PG, TR, BS, MS, RMC. Critical revision of the manuscript for important intellectual content: IMK, SNH, MSL, MMS. Statistical analysis: PG, TR, BS, MS. Administrative, technical, or material support: IMK, MSL, MMS. Study supervision: SNH, MSL, MMS.

Corresponding author

Correspondence to Parag Goyal.

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Funding

National Institute on Aging grant R03AG056446 (Principal Investigator [PI]: PG); National Cancer Institute grant K07CA207580 (PI: MS); National Institute of Nursing Research grant R00NR016275 (PI: RMC). These institutions did not have a role in the design, methods, subject recruitment, data collections, analysis, or preparation of the manuscript.

Conflicts of interest

Dr. Safford reports research support from Amgen. Parag Goyal, Tatiana Requijo, Birgit Siceloff, Megan J. Shen, Ruth Masterson Creber, Sarah N. Hilmer, Ian M. Kronish, and Mark S. Lachs report no conflicts of interest.

Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Weill Cornell Medicine Institutional Review Board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all study participants.

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Goyal, P., Requijo, T., Siceloff, B. et al. Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications. Drugs Aging 37, 125–135 (2020). https://doi.org/10.1007/s40266-019-00729-x

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