Optimizing Medications in Patients with Cardiovascular Disease: A Case Report on Unrecognized Prescribing Cascades in Older Adults

Research Publications | 2 Minute Read

Ha M; Meyer K; Matos A; Turgeon J; * Chandni Bardolia;

Abstract

Objective: Older adults with cardiovascular diseases are especially prone to polypharmacy due to comorbidities and consequent complexity of medication regimens. Prescribing cascades can occur when a side effect is misinterpreted as a new medical condition. Although the act of deprescribing is an integral part of good prescribing practice, it can be difficult to initiate without surveillance, appropriate communication, and primary care physician advocacy. This case demonstrates how a healthcare team works together to approach and resolve a prescribing cascade in a patient with chronic heart failure.

Case Presentation: An 87-year-old female with chronic heart failure (CHF) was experiencing potential side effects related to polypharmacy. Her long-term diltiazem therapy was identified as a cause of her edema and was deemed no longer appropriate due to the progression of her CHF. The worsening edema led to the prescribing of furosemide, resulting in the need for potassium supplementation. Opportunities to optimize this patient’s medication regimen were recognized as well, including reducing pill burden and assessing the need for additional care based on comorbidities. The patient’s new healthcare team, including the clinical pharmacist and cardiologist, collaborated to resolve the prescribing cascade and create a personalized pharmacotherapy strategy, which resulted in notable improvements in her symptoms.

Conclusion: Resolving prescribing cascades can be a difficult process, as a number of steps and healthcare professionals are often involved. Deprescribing should be a top priority in medication safety, particularly for older adults with cardiovascular disease. Polypharmacy interventions are necessary to encourage safe use and improve patients’ overall wellbeing.

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