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Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction
Pedram Navid1, Linh Nguyen2, Diana Jaber3
1Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
Insights
Most heart failure with preserved ejection fraction patients are open to deprescribing medications. However, nonwhite patients showed less willingness to try stopping medications, highlighting race as a potential factor in deprescribing attitudes.
Area of Science:
- Geriatrics
- Cardiology
- Pharmacology
Background:
- Patients with heart failure with preserved ejection fraction (HFpEF) often have multiple health issues and medications.
- Deprescribing, the process of reducing or stopping medications, is a key consideration for this population.
- Understanding patient attitudes toward deprescribing is crucial for effective care.
Purpose of the Study:
- To investigate patient attitudes towards medication deprescribing in individuals with HFpEF.
- To identify factors, including race, that may influence these attitudes.
Main Methods:
- A retrospective cohort study was conducted at an academic medical center.
- Data from 134 patients with HFpEF were analyzed, including demographics, comorbidities, and medication use.
- Patient attitudes toward deprescribing were assessed using the revised Patient Attitudes Toward Deprescribing (rPATD) scale.
Main Results:
- The majority of HFpEF patients (90.3%) were willing to consider deprescribing.
- A significant portion (26.9%) expressed a desire to try stopping a medication to assess its impact.
- Nonwhite participants were less likely to want to try stopping medications (OR 0.25, p=0.005).
Conclusions:
- Patients with HFpEF generally exhibit positive attitudes towards deprescribing.
- The high prevalence of polypharmacy, multimorbidity, and frailty in this group supports deprescribing considerations.
- Racial differences in attitudes toward deprescribing warrant further investigation and tailored approaches.
Background/Objectives:
Attitudes toward deprescribing could vary among subpopulations. We sought to understand patient attitudes toward deprescribing among patients with heart failure with preserved ejection fraction (HFpEF).
Design:
Retrospective cohort study.
Setting:
Academic medical center in New York City.
Participants:
Consecutive patients with HFpEF seen in July 2018-December 2019 at a program dedicated to providing care to older adults with HFpEF.
Measurements:
We assessed the prevalence of vulnerabilities outlined in the domain management approach for caring for patients with heart failure and examined data on patient attitudes toward having their medicines deprescribed via the revised Patient Attitudes Toward Deprescribing (rPATD).
Results:
Among 134 patients with HFpEF, median age was 75 (interquartile range 69-82), 60.4% were women, and 35.8% were nonwhite. Almost all patients had polypharmacy (94.0%) and 56.0% had hyperpolypharmacy; multimorbidity (80.6%) and frailty (78.7%) were also common. Overall, 90.3% reported that they would be willing to have one or more of their medicines deprescribed if told it was possible by their doctors; and 26.9% reported that they would like to try stopping one of their medicines to see how they feel without it. Notably, 91.8% of patients reported that they would like to be involved in decisions about their medicines. In bivariate logistic regression, nonwhite participants were less likely to want to try stopping one of their medicines to see how they feel without it (odds ratio 0.25, 95% confidence interval [0.09-0.62], p = 0.005).
Conclusions:
Patients with HFpEF contend with many vulnerabilities that could prompt consideration for deprescribing. Most patients with HFpEF were amenable to deprescribing. Race may be an important factor that impacts patient attitudes toward deprescribing.
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