Discontinuation of Statins in Routine Care Settings

Abstract

Background Systematic data on discontinuation of statins in routine practice of medicine are limited. Objective To investigate reasons for statin discontinuation and the role of statin-related events (clinical events / symptoms thought to have been caused by statins) in routine care settings. Design A retrospective cohort study Setting Practices affiliated with one of two academic hospitals. Patients Adults who received a statin prescription between 01/01/2000 and 12/31/2008. Measurements Information on reasons for statin discontinuations was obtained from a combination of structured electronic medical record (EMR) entries and analysis of electronic provider notes by validated software. Results Statins were discontinued at least temporarily for 57,292 out of 107,835 patients. Statin-related events were documented for 18,778 (17.4%) patients. Statins were discontinued at least temporarily by 11,124 of these patients, 6,579 (59.1%) of whom were rechallenged with a statin over the subsequent 12 months. Most patients who were rechallenged (92.2%) were still taking a statin 12 months after the statin-related event. Among the 2,721 patients who were rechallenged with the same statin to which they had a statin-related event, 1,295 (47.6%) were on the same statin 12 months later, including 996 on the same or higher dose. Limitation Statin discontinuations and statin-related events were assessed in practices affiliated with two academic medical centers. Utilization of secondary data could have led to missing or misinterpreted data as a result of incomplete documentation. Natural language processing tools used to compensate for the low (30%) proportion of reasons for statin discontinuation documented in structured EMR fields are not perfectly accurate. Conclusion Statin-related events are commonly reported and often lead to their discontinuation. However, most patients who are rechallenged can tolerate statins long-term. This suggests that many of the statin-related events may have other etiologies, are tolerable or may be specific to individual statins rather than the entire drug class.

Interpretation of the evidence for the efficacy and safety of statin therapy

“…primary care or hospital data that are being used for patient care or administrative purposes). [91][92][93][94][95] In addition, whereas randomized trials assess the effects of a specific exposure (i.e. a particular dose of a particular drug with information about adherence) on outcomes that are sought systematically, observational studies often only assess more general associations (e.g.…”

Lipids, blood pressure and kidney update 2014

“…It is important to emphasize that using "take your time" approach we are able to keep the statin therapy in even 90 % of patients previously suggested as statin intolerant. Taking into account the above definition it does not mean these patients are not statin intolerant (=partial intolerance), however, it is important to emphasize that having and opportunity to use even small dose of statin, we are able to prevent CV risk much more effectively [47][48][49].…”

Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction

“…While statin use for secondary prevention of CHD among adults aged ≥65 years old increased between 2002 and 2003 and 2012 and 2013,5 it is commonly reported that >25% of patients discontinue this treatment within 1 year 6, 7, 8. However, many patients who discontinue statins frequently re‐initiate therapy 9, 10, 11. Among Medicare beneficiaries who discontinued statin treatment following a myocardial infarction, 53.7% re‐initiated therapy within 1 year 12…”