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老年心力衰竭患者的减药策略。

Deprescribing strategies in older patients with heart failure.

作者信息

Tersalvi Gregorio, Beltrani Vittorio, Peronti Marco, Furlan Ludovico, Foy Andrew, Biasco Luigi

机构信息

Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

出版信息

Intern Emerg Med. 2025 Mar;20(2):599-609. doi: 10.1007/s11739-024-03791-5. Epub 2024 Oct 15.

Abstract

Older patients with heart failure are particularly vulnerable due to a wide range of associated comorbidities, disability, and frailty. This population often receives multiple prescriptions, increasing the risk of adverse drug reactions, non-adherence, and drug interactions. Deprescribing, which involves reducing the number of medications to the lowest clinically reasonable limit, has the potential to decrease the risk of drug interactions and enhance patients' quality of life. Moreover, simplifying medication regimens may improve adherence to essential heart failure therapies. This scientific review aims to comprehensively examine deprescribing strategies in older patients with heart failure. It explores the rationale, challenges, benefits, and potential approaches to optimizing medication regimens in this vulnerable population. Furthermore, the review suggests a practical, step-by-step approach for performing deprescribing in older patients with heart failure.

摘要

由于存在多种相关的合并症、残疾和身体虚弱,老年心力衰竭患者特别容易受到影响。这一人群经常接受多种药物处方,增加了药物不良反应、不依从性和药物相互作用的风险。减药,即把药物数量减少到临床上合理的最低限度,有可能降低药物相互作用的风险并提高患者的生活质量。此外,简化药物治疗方案可能会提高对基本心力衰竭治疗的依从性。本科学综述旨在全面研究老年心力衰竭患者的减药策略。它探讨了在这一脆弱人群中优化药物治疗方案的基本原理、挑战、益处和潜在方法。此外,该综述还提出了一种针对老年心力衰竭患者进行减药的实用的、循序渐进的方法。

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