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Case Report

Abstract

Background: Since 2004, the number of adults aged 65 and older has increased by 5.6%. With a growing geriatric population, medical management should maximize benefits and minimize risks. Polypharmacy, defined as the concurrent use of 5 or more medications, is a common concern in older adults. In adults 80 years and older, the prevalence of polypharmacy is 67.1%. Among adults with heart disease, the prevalence of polypharmacy increased from 40.6% to 61.7% between 2000 and 2018. In the context of heart failure, guideline-directed medical therapy (GDMT) includes beta-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Diuretics are guideline-recommended medications for symptomatic control. However, the American Geriatrics Society (AGS) Beers Criteria indicates certain risks associated with these medications. RAAS inhibitors may contribute to drug-drug interactions in older adults, such as hyperkalemia. Specifically, spironolactone should be avoided or reduced depending on kidney function. Although not contraindicated in the Beers Criteria, beta blockers and diuretics are associated with increased risk of hypotension. Therefore, these agents should be monitored to avoid adverse events in older adults.

Case Presentation: We present the case of a 91-year-old female with an extensive medical history of combined systolic and diastolic congestive heart failure, paroxysmal atrial fibrillation, chronic obstructive pulmonary disease, hiatal hernia with gastroesophageal reflux, hypothyroidism, anxiety disorder, and dementia. The patient previously had a urinary tract infection, which has since resolved. A recent CT of the abdomen and pelvis showed no acute findings. A psychiatric nurse practitioner recently noted an episode of low blood pressure. At this visit, the patient was asymptomatic with normal vitals except for a blood pressure of 97/56 mmHg. Despite having a caretaker, the patient remains physically active and performs all her basic activities of daily living.

Heart failure therapy is associated with improved survival in patients aged 80 and older. Therefore, treatment should be tailored to the patient’s age, comorbidities, functional status, and preferences. During this visit, spironolactone was discontinued, and carvedilol was reduced from 12.5 mg twice daily to 6.25 mg twice daily due to the patient’s low blood pressure. Omeprazole was continued after noting the patient had a large hiatal hernia, intolerance to H2 blockers in the past, and most significantly, was hospitalized for aspiration pneumonia early in 2025. Gabapentin 100 mg three times daily was continued, as the patient reported no adverse effects and effective management of degenerative disc disease-related pain with the current dose. As the patient was under the management of a psychiatric specialist, seven medications from that prescriber were continued. The patient and her daughter expressed gratitude for simplifying her medical regimen.

Conclusions: This report highlights that age alone is not a contraindication to polypharmacy, even in the context of heart failure. Prescribing and deprescribing medications should reflect each patient’s comorbidities, level of independence, and personal goals. Individualized dosing and shared decision-making facilitate effective medical management in adults aged 80 and older.

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Deprescribing and Polypharmacy in Heart Failure Patients Aged 80 Years and Older: A Case Report

Background: Since 2004, the number of adults aged 65 and older has increased by 5.6%. With a growing geriatric population, medical management should maximize benefits and minimize risks. Polypharmacy, defined as the concurrent use of 5 or more medications, is a common concern in older adults. In adults 80 years and older, the prevalence of polypharmacy is 67.1%. Among adults with heart disease, the prevalence of polypharmacy increased from 40.6% to 61.7% between 2000 and 2018. In the context of heart failure, guideline-directed medical therapy (GDMT) includes beta-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Diuretics are guideline-recommended medications for symptomatic control. However, the American Geriatrics Society (AGS) Beers Criteria indicates certain risks associated with these medications. RAAS inhibitors may contribute to drug-drug interactions in older adults, such as hyperkalemia. Specifically, spironolactone should be avoided or reduced depending on kidney function. Although not contraindicated in the Beers Criteria, beta blockers and diuretics are associated with increased risk of hypotension. Therefore, these agents should be monitored to avoid adverse events in older adults.

Case Presentation: We present the case of a 91-year-old female with an extensive medical history of combined systolic and diastolic congestive heart failure, paroxysmal atrial fibrillation, chronic obstructive pulmonary disease, hiatal hernia with gastroesophageal reflux, hypothyroidism, anxiety disorder, and dementia. The patient previously had a urinary tract infection, which has since resolved. A recent CT of the abdomen and pelvis showed no acute findings. A psychiatric nurse practitioner recently noted an episode of low blood pressure. At this visit, the patient was asymptomatic with normal vitals except for a blood pressure of 97/56 mmHg. Despite having a caretaker, the patient remains physically active and performs all her basic activities of daily living.

Heart failure therapy is associated with improved survival in patients aged 80 and older. Therefore, treatment should be tailored to the patient’s age, comorbidities, functional status, and preferences. During this visit, spironolactone was discontinued, and carvedilol was reduced from 12.5 mg twice daily to 6.25 mg twice daily due to the patient’s low blood pressure. Omeprazole was continued after noting the patient had a large hiatal hernia, intolerance to H2 blockers in the past, and most significantly, was hospitalized for aspiration pneumonia early in 2025. Gabapentin 100 mg three times daily was continued, as the patient reported no adverse effects and effective management of degenerative disc disease-related pain with the current dose. As the patient was under the management of a psychiatric specialist, seven medications from that prescriber were continued. The patient and her daughter expressed gratitude for simplifying her medical regimen.

Conclusions: This report highlights that age alone is not a contraindication to polypharmacy, even in the context of heart failure. Prescribing and deprescribing medications should reflect each patient’s comorbidities, level of independence, and personal goals. Individualized dosing and shared decision-making facilitate effective medical management in adults aged 80 and older.

 

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