Changes in Statin Prescription Patterns in Patients Admitted to an Australian Geriatric Subacute Unit

Noaman, Samer; Al-Mukhtar, Omar; Abramovic, Sheri; Mohammed, Hanin; Goh, Cheng Yee; Long, C.; Neil, Christopher; Janus, Edward; Cox, Nicholas; Chan, William

doi:10.1016/j.hlc.2017.12.009

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…The effect of burden of medication use and comorbidity status has not been widely explored in relation to statin discontinuation. One previous study found that discontinuation rates were modestly increased with increasing frailty in prevalent users (>1 year of use) while another found no effect of comorbidity status . In our study, a moderate or high comorbidity score was generally associated with a modest increased likelihood of discontinuation, while a high burden of medication use was associated with a modest increase in odds of discontinuation at 2 and 4 years after initiation.…”

Section: Discussioncontrasting

confidence: 50%

“…One previous study found that discontinuation rates were modestly increased with increasing frailty in prevalent users (>1 year of use) 19 while another found no effect of comorbidity status. 17 In our study, a moderate or high comorbidity score was generally associated with a modest increased likelihood of discontinuation, while a high burden of medication use was associated with a modest increase in odds of discontinuation at 2 and 4 years after initiation. Our findings on discontinuation in secondary vs primary prevention are also consistent with previous research.…”

Section: Discussionsupporting

confidence: 43%

“…Rates of statin discontinuation have previously been investigated, although these studies have mostly focused on the general population, [13][14][15] either excluding those older than 80 years or grouping them together. [16][17][18] Existing studies in older persons have further been limited by small sample sizes, 17 limited numbers of factors being investigated, 19 or only examining the first year of statin use. 16 Further, some studies have focused on discontinuation primarily from an adherence or persistence standpoint.…”

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confidence: 99%

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Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use

Thompson

Jarbøl

Haastrup

et al. 2019

J American Geriatrics Society

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BACKGROUND AND OBJECTIVE Use of statins is considerable among older persons. We investigated factors associated with statin discontinuation in new statin users aged 70 years or older within the first 4 years of use. DESIGN Register‐based descriptive drug utilization study using data from 2008 to 2016. POPULATION/SETTING All Danish persons, aged 70 years or older, initiating statin treatment. MEASUREMENTS Rates and predictors of statin discontinuation after 1 year (early), 2 years, and 4 years. Predictors of discontinuation were estimated using logistic regression. RESULTS We included 83 788 statin initiators. At 1 year, 13% had discontinued their treatment, while another 12% and 13% discontinued after 2 and 4 years, respectively. The overall discontinuation rate over 4 years was 32%. Increasing age was associated with discontinuation at all time points (adjusted odds ratio [OR] = 2.06 [95% confidence interval {CI} = 1.35‐3.16] at 1 year, adjusted OR = 3.94 [95% CI, 1.83‐8.49] at 4 years, comparing those aged >95 years to those aged 70‐74 years). Further, higher comorbidity scores and use of more than 10 medications were modestly associated with discontinuation. Use of statins for secondary prevention was associated with decreased odds of discontinuation compared to primary prevention at 1 year (adjusted OR = 0.74; 95% CI, 0.65‐0.83) and at 4 years (adjusted OR = 0.83; 95% CI, 0.72‐0.95), along with concomitant use of cardiovascular (CV) therapies. The annual proportion of early discontinuers ranged from 14% to 17% for primary prevention and from 9% to 12% for secondary prevention between 2008 and 2015. DISCUSSION Statin discontinuation within the first 4 years after initiation appeared to be influenced most strongly by age, and may also be influenced by comorbidity, polypharmacy, use for secondary prevention, and concomitant CV medication use. Future research should clarify reasons for, and discussions about, statin discontinuation and initiation among older persons, to provide additional insight on this topic. J Am Geriatr Soc 67:2050–2057, 2019

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionsupporting

confidence: 43%

mentioning

confidence: 99%

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Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use

Thompson

Jarbøl

Haastrup

et al. 2019

J American Geriatrics Society

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“…Our findings are similar to previous studies involving patients admitted to intermediate care units for heterogeneous reasons, i.e., not only for specific conditions such as those addressed to rehabilitation-oriented settings [ 11 – 16 ]. For example, we found that patients with impaired cognition, assessed with the MMSE (i.e., a score less than 24/30), accounted for 37.7% of the whole study population, a finding that is very similar to the one reported by Gual et al [ 13 ] and Noaman et al [ 14 ]. Delirium occurred in 14.5% of subjects, similar to the proportion reported by Bellelli et al [ 11 ].…”

Section: Discussionsupporting

confidence: 89%

Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience

Mazzola

Buttò²,

Elli³

et al. 2021

Aging Clin Exp Res

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Background The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home. Aims We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome). Methods This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome. Results Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home. Discussion and conclusion The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.

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How Common is Statin Use in the Oldest Old?

et al. 2018

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There is a lack of evidence surrounding the efficacy of statins in the oldest old (≥ 80 years of age). As such, there is controversy surrounding use of statins in this population. We sought to evaluate the prevalence of statin use in the oldest old worldwide to understand the scope of this issue. We searched PubMed and grey literature over the last 5 years. Studies had to report the prevalence of statin use in adults ≥ 80 years of age. The first author performed screening and extracted data. Our search produced 1870 hits; 14 articles were considered eligible. We found three studies of nursing home residents, eight studies of community-dwelling patients and three studies in the combined population (i.e., both community-dwelling patients and nursing home residents). The prevalence of statin use ranged from 17 to 39% in nursing home residents, 12 to 59% for community-dwelling patients and 18 to 45% in combined populations. Beyond age 80 years, the prevalence of statin use appeared to decrease with advancing age. Statin use was more common as secondary prevention compared with primary prevention. The prevalence of statin use in the oldest old has increased over recent decades. The increase in prevalence appears to be more pronounced in the oldest old compared with younger old, as reported by two studies. Statins are widely used in the oldest old despite the lack of evidence in this population. Given how common statin use is in the oldest old, clinical evidence surrounding their efficacy in this group is urgently needed to guide appropriate use and shared decision-making.

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Changes in Statin Prescription Patterns in Patients Admitted to an Australian Geriatric Subacute Unit

Cited by 5 publications

References 28 publications

Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use

Statins in Older Danes: Factors Associated With Discontinuation Over the First 4 Years of Use

Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience

How Common is Statin Use in the Oldest Old?

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