With increasing age, comorbidity, and frailty, the balance between potential harms and benefits of long-term medication may shift, requiring doctors to reconsider whether continued prescription is still justified. This appears especially true for preventive medication, such as cardiovascular drugs. Yet, in daily practice, deprescription (reduction or discontinuation) is often neglected, and there have been reports of over one-third of older patients using potentially inappropriate medication.1 In this editorial, we aim to encourage practising GPs to consider deprescription as part of their clinical routine.
BENEFIT-TO-HARM RATIO OF CARDIOVASCULAR MEDICATION
Guidelines on cardiovascular risk management offer clear directives to prescribe preventive drugs for patients in midlife, but lack consensus for older patients, as this age group was long underrepresented in randomised controlled trials. Over the last two decades, more trials with older participants have been performed. These have demonstrated that some cardiovascular drugs, such as antihypertensive medication, can effectively prevent cardiovascular disease, even for the oldest old (>80 years).2 However, it is questionable whether the results of these trial populations can be generalised to the older population, including multimorbid or frail patients. In addition, as these trials have an average follow-up of <5 years and mortality rates were relatively low,2 it is unclear whether preventive treatment remains useful for persons with a limited life expectancy due to, for example, advanced stages of cancer, chronic obstructive pulmonary disease, or heart failure. The heterogeneity among older patients inherently complicates preventive treatment and precludes use of the one-size-fits-all approach that is generally tested in randomised controlled trials. Meanwhile, side effects, …