Politerapia e deprescrizione in cardiologia

Inappropriate prescribing of diagnostic procedures and treatments should be avoided for good medical practice. Furthermore, the therapeutic plan of each patient should be regularly revised, activating deprescription procedures to reduce the dosage or to discontinue unnecessary drugs. It has widely been reported that the number of drugs taken by each patient increases over the years and adverse events caused by polypharmacy therapy are increasingly reported. Polypharmacy is due to multimorbidity related to longer life expectancy, but it is also induced by drug manufacturers' pressures, the practice of prescribing one product to counteract the adverse effects of another, the division into subspecialties inducing clinicians to solve the specific problem regardless of the patient therapeutic profile, and the uncritical implementation of current guidelines. The recommendations published by scientific societies for the international Choosing Wisely project allow to identify practices at risk of inappropriateness, and programs are available to help evaluating the risks of several drug associations, taking into consideration different aspects of pharmacology, drug interactions, potentially inappropriate in the elderly, according to different criteria from the scientific literature. The safety of reducing or withdrawing under strict medical supervision some cardiovascular treatments has been demonstrated, with documented benefits for the patients.