Top Things to Know: Deprescribing in Patients with Cardiovascular Disease Experiencing Polypharmacy
Updated: July 08, 2026
Prepared by Paul St. Laurent, DNP, RN National Vice President, Science & Medicine, American Heart Association
- Polypharmacy (≥5 chronic medications) and hyperpolypharmacy (≥10 medications) are increasingly prevalent, with the highest burden seen among patients with cardiovascular disease (CVD).
- Guideline-directed medical therapy (GDMT) in CV care often requires multiple medications across coexisting conditions and comorbidities, making polypharmacy common in routine practice.
- Higher medication burden in CVD is associated with worse outcomes, including more adverse drug events, hospitalizations, increase in mortality, reduced adherence, and higher healthcare costs.
- As medication regimens become more complex, drug burden can create a harmful cycle in which adherence declines, adverse effects increase, and new symptoms lead to additional prescribing through prescribing cascades.
- Deprescribing is a core component of high-quality CV care, defined as supervised dose reduction or discontinuation to optimize medication use and align treatment with patient goals, prognosis, and preferences.
- Deprescribing can be beneficial when polypharmacy, prescribing cascades, poor adherence, adverse drug events, or changing goals of care warrant treatment reassessment.
- Patients with advanced illness and palliative care needs are among the groups most likely to benefit from deprescribing.
- Structured approaches to deprescribing, including medication reconciliation and validated tools such as the Beers Criteria, STOPP/START, and the Medication Appropriateness Index, can help identify potentially inappropriate medications.
- Patient-centered frameworks such as the 4Ms (What Matters, Medication, Mentation, Mobility), 5Ms (Mind, Mobility, Medications, Multimorbidity, Matters Most), and domain management model embed deprescribing into holistic, coordinated care.
- Safe deprescribing requires structured implementation within a multidisciplinary framework, including shared decision-making, appropriate tapering, and close monitoring for withdrawal or disease recurrence.
Citation
DiDomenico RJ, Marrs JC, Bress AP, Denfeld QE, Dobesh PP, Effron MB, Goyal P, Onyebeke C, Peterson JK, Petrovic M; on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Quality of Care and Outcomes Research. Deprescribing in patients with cardiovascular disease experiencing polypharmacy: a scientific statement from the American Heart Association. Circulation. Published online July 8, 2026. doi: 10.1161/CIR.0000000000001459.