BACKGROUND/OBJECTIVES Guideline‐based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties. DESIGN National cross‐sectional survey. SETTING Ambulatory. PARTICIPANTS Random sample of geriatricians, general internists, and cardiologists from the American College of Physicians. MEASUREMENTS Electronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases. RESULTS In each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists). CONCLUSIONS While barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician‐physician and physician‐patient communication. J Am Geriatr Soc 68:78–86, 2019

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Background Representation by age ensures appropriate translation of clinical trial results to practice, but historically, older patients were underrepresented in clinical trial populations. As the general population has aged, it is unknown whether clinical trial enrollment has changed in parallel. Methods and Results We studied time trends in enrollment, clinical characteristics, treatment, and outcomes by age among 76,141 NSTE ACS patients enrolled in 11 phase III clinical trials over 17 years (1994–2010). Overall, 19.7% of patients were ≥75 years; this proportion increased from 16% during 1994–1997 to 21% during 1998–2001 and 23.2% during 2002–2005, but declined to 20.2% in 2006–2010. The number of comorbidities increased with successive time periods irrespective of age. There were substantial increases in use of evidence-based medication in-hospital and at discharge regardless of age. While predicted 6-month mortality increased slightly over time, observed 6-month mortality declined significantly in all age strata (1994–1997 vs. 2006–2010: <65 years: 3.0% vs. 1.9%; 65–74 years: 7.5% vs. 3.4%; 75–79 years: 13.0% vs. 6.5%; 80–84 years: 17.6% vs. 8.2%; and ≥85 years: 24.8% vs. 12.6%). Conclusions The distribution of enrollment by age in phase III NSTE ACS trials was unchanged over time. Irrespective of age, post-myocardial infarction mortality decreased significantly over time, concurrent with increased evidence-based care and despite increasing comorbidities. Clinical Trial Registration Information ClinicalTrials.gov. Identifier: NCT00089895.

This cross-sectional survey study describes the cardiopulmonary resuscitation preferences of patients receiving dialysis and how these preferences are associated with their responses to questions about other aspects of end-of-life care.

This cohort study examines differences regarding existential and supportive care needs for patients with kidney disease between individuals of racial and ethnic minority groups compared with White individuals.

With age, presynaptic uptake as measured by PSnt declines, but there were no differences in β'max. Endurance training significantly increased VO2 max but did not cause any changes in the measures of cardiac sympathetic nervous system function. These findings suggest that significant changes do not occur or that current PET imaging methods may be inadequate to measure small serial differences in a highly reproducible manner.

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