cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2020.3.n779cardio-779Research ArticleОБЗОРЫREVIEWSЛечение хронической сердечной недостаточности: возможен ли депрескрайбинг?Treatment of chronic heart failure: is deprescribing possible?https://orcid.org/0000-0002-4193-688XТкачеваО. Н.TkachevaO. N.

доктор медицинских наук, профессор. Главный внештатный специалист гериатр Минздрава России. Директор ОСП «Российский геронтологический научно-клинический центр» ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России. Президент Российской ассоциацией геронтологов и гериатров. Заведующая кафедрой болезней старения ФДПО ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России

MD, PhD, professor. Chief specialist-geriatrician of the Ministry of health of the Russian Federation. Head of Russian Clinical and Research Center of Gerontology. President of Russian Association of Gerontologists and Geriatricians. Head of chair of aging diseases, N.I. Pirogov Russian National Research Medical University

tkacheva@rgnkc.ruhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

доктор медицинских наук, профессор. Заведующая лабораторией клинической фармакологии и фармакотерапии ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России – ОСП «Российский геронтологический научно-клинический центр»

MD, PhD, professor. Head of laboratory of clinical pharmacology and pharmacotherapy, Russian clinical and research center of gerontology, N.I. Pirogov Russian National Research Medical University

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-1628-5093КотовскаяЮ. В.KotovskayaYu. V.

доктор медицинский наук, профессор. Заместитель директора по научной работе, заведующая лабораторией сердечно-сосудистого старения  ОСП Российский геронтологический научно-клинический центр ФГБОУ ВО Российского национального исследовательского медицинского университета им. Н.И. Пирогова Минздрава России. Вице-Президент Российской ассоциации геронтологов и гериатров

MD, PhD, professor. Deputy Director for Science of Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University, vice-president of Russian Association of Gerontologists and Geriatricians

kotovskaya@bk.ruhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

кандидат медицинских наук, научный сотрудник лаборатории клинической фармакологии и фармакотерапии ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России – ОСП «Российский геронтологический научно-клинический центр», ассистент кафедры болезней старения ФДПО ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России.SPIN 9212-6010

MD, PhD, researcher, laboratory of clinical pharmacology and pharmacotherapy of Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University. Assistant of chair of aging diseases, N.I. Pirogov Russian National Research Medical University

ak_info@list.ruhttps://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

кандидат медицинских наук, научный сотрудник лаборатории клинической фармакологии и фармакотерапии ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России – ОСП «Российский геронтологический научно-клинический центр»

MD, PhD, researcher, laboratory of clinical pharmacology and pharmacotherapy of Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University

acchirurg@mail.ruhttps://orcid.org/0000-0002-7622-5850КрасновГ. С.KrasnovG. S.

клинический ординатор, ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Минздрава России – ОСП «Российский геронтологический научно-клинический центр»

resident physician, Russian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical University

gsk.samar@yandex.ruРоссийский геронтологический научно-клинический центр, Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава РФРоссияRussian Clinical and Research Center of Gerontology, N.I. Pirogov Russian National Research Medical UniversityRussian Federation202020012020603126136Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/779

Депрескрайбинг – это практика запланированной отмены, снижения дозы или замены лекарственного средства на более безопасное. В лечении хронической сердечной недостаточности (ХСН) используются одновременно несколько групп лекарственных средств (ЛС), что повышает риск развития нежелательных лекарственных реакций, особенно у пациентов пожилого и старческого возраста. В результате систематического поиска и анализа литературы была оценена возможность депрескрайбинга следующих лекарственных групп: 1) ЛС, влияющие на ренин-ангиотензин-альдостероновую систему, 2) бета-блокаторы, 3) дигоксин, 4) диуретики. Были проанализированы 3 систематических обзора и ряд исследований для определения наиболее возможных и потенциально оптимальных режимов депрескрайбинга при ХСН. Определено, что депрескрайбинг при ХСН имеет крайне ограниченный потенциал применения из-за доказанного очевидного влияния ряда групп ЛС на прогноз и выраженность клинической симптоматики у пациентов с ХСН.

Deprescribing is a scheduled withdrawal, dose reduction, or replacement of a medicine with a safer one. Several groups of medicinal products (MPs) are used simultaneously in the treatment of chronic heart failure. This increases the risk of adverse drug reactions, particularly in elderly and senile patients. A systematic search for literature allowed evaluating possibilities of deprescribing for the following pharmaceutic groups: 1) MPs influencing the renin-angiotensin-aldosterone system; 2) beta-blockers; 3) digoxin; and 4) diuretics. Three systematic reviews and several studies were analyzed to determine the most feasible and potentially optimal regimens of deprescribing in CHF. It was established that in CHF, deprescribing has a very limited potential for use due to the documented, obvious effect of some MP groups on prediction and severity of clinical symptoms in CHF patients.

Cердечная недостаточностьпожилой и старческий возрастдепрескрайбингполипрагмазияингибиторы ангиотензинпревращающего ферментаблокаторы рецепторов к ангиотензину IIбета-блокаторыдиуретикидигоксинHeart failureelderly and senile agedeprescribingpolypragmasiaangiotensin-converting enzyme inhibitorsangiotensin II receptor blockersbeta-blockersdiureticsdigoxinнетReferencesJetha S. Polypharmacy, the Elderly, and Deprescribing. The Consultant Pharmacist. 2015;30(9):527–32. DOI: 10.4140/TCP.n.2015.527Jetha S. Polypharmacy, the Elderly, and Deprescribing. The Consultant Pharmacist. 2015;30(9):527–32. DOI: 10.4140/TCP.n.2015.527Tkacheva O. N., Ostroumova O. D., Kotovskaya Yu. V., Pereverzev A. P., Krasnov G. S. Deprescribing of proton pump inhibitors in the elderly. Clinical pharmacology and therapy. 2019;27 (1):70–4. [Russian: Ткачева О. Н., Остроумова О. Д., Котовская Ю. В., Переверзев А. П., Краснов Г. С. Депрескрайбинг ингибиторов протонной помпы у пациентов пожилого и старческого возраста. 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The authors declare that there are no conflicts of interest present.