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Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy.

  • Tamargo, Juan1
  • Kjeldsen, Keld Per2
  • Delpón, Eva3
  • Semb, Anne Grete4
  • Cerbai, Elisabetta5
  • Dobrev, Dobromir6
  • Savarese, Gianluigi7
  • Sulzgruber, Patrick8
  • Rosano, Giuseppe9
  • Borghi, Claudio10
  • Wassman, Seven11
  • Torp-Pedersen, Christian Tobias12
  • Agewall, Stefan13
  • Drexel, Heinz14
  • Baumgartner, Iris15
  • Lewis, Basil16
  • Ceconi, Claudio17
  • Kaski, Juan Carlos18
  • Niessner, Alexander8
  • 1 Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain. , (Spain)
  • 2 Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, and Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark. , (Denmark)
  • 3 Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid,Spain. , (Spain)
  • 4 Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway. , (Norway)
  • 5 Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy. , (Italy)
  • 6 Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany. , (Germany)
  • 7 Division of Cardiology, Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. , (Sweden)
  • 8 Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. , (Austria)
  • 9 Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy. , (Italy)
  • 10 Medicine and Surgery Science Department, University of Bologna, Bologna, Italy. , (Italy)
  • 11 Cardiology Pasing, Munich, and Faculty of Medicine, University of the Saarland, Homburg/Saar, Germany. , (Germany)
  • 12 Department of Cardiology, Nordsjaellands Hospital, and Department of Public Health, University of Copenhagen, Copenhagen, Denmark. , (Denmark)
  • 13 Department of Cardiology, Oslo University Hospital, Oslo, Norway. , (Norway)
  • 14 Department of Internal Medicine and Cardiology, VIVIT Institute, Landeskrankenhaus Feldkirch, Feldkirch, Austria. , (Austria)
  • 15 Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland. , (Switzerland)
  • 16 Department of Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. , (Israel)
  • 17 UO Cardiologia, Ospedale di Desenzano del Garda, Desenzano del Garda, Italy. , (Italy)
  • 18 Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
Published Article
European heart journal. Cardiovascular pharmacotherapy
Publication Date
Jun 08, 2022
DOI: 10.1093/ehjcvp/pvac005
PMID: 35092425


Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

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