Deprescribing in Cardiovascular Disease: A New AHA Roadmap for Tackling Polypharmacy

In this episode of The Tell-Tale Heart, host Craig Beavers, PharmD, welcomes back Robert J. DiDomenico, PharmD, FAHA, chair of the writing committee behind a new American Heart Association (AHA) scientific statement on deprescribing in patients with cardiovascular disease experiencing polypharmacy. DiDomenico explains that polypharmacy, generally defined as taking 5 or more medications, affects roughly 60% of patients with cardiovascular disease and up to three-quarters of those with heart failure, contributing to adverse events, poor adherence, and increased hospitalizations. He outlines 4 patient groups who warrant closer evaluation: those experiencing adverse drug events, polypharmacy or hyperpolypharmacy, prescribing cascades, and those receiving palliative or end-of-life care. DiDomenico stresses that accurate medication reconciliation is the essential starting point, followed by use of tools such as the Beers criteria and STOPP/START to flag potentially inappropriate medications. He also highlights shared decision-making as critical to preserving patient trust during the deprescribing process. The conversation touches on newly announced CMS billing codes supporting deprescribing services, along with persistent gaps: a need for more robust outcomes data, expanded reimbursement mechanisms, and greater inclusion of deprescribing content in health professions curricula. DiDomenico notes the statement also addresses pediatric populations, an often-overlooked area in polypharmacy research.