Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

Ploeg, Milly A. van der; Streit, Sven; Achterberg, Wilco P.; Beers, Erna; Bohnen, Arthur M.; Burman, Robert Anders; Collins, Claire; Franco, Fabio; Gerasimovska-Kitanovska, Biljana; Gintere, Sandra; Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Peštić, Sanda Kreitmayer; Koskela, Tuomas; Kurpas, Donata; Maisonneuve, Hubert; Mallen, Christian; Merlo, Christoph; Müeller, Yolanda; Muth, Christiane; Petrazzuoli, Ferdinando; Rodondi, Nicolas; Rosemann, Thomas; Sattler, Martin; Schermer, Tjard; Šter, Marija Petek; Švadlenková, Zuzana; Tatsioni, Athina; Thulesius, Hans; Ткаченко, В. І.; Torzsa, Péter; Tsopra, Rosy; Tuz, Canan; Vaes, Bert; Viegas, Rita P. A.; Vinker, Shlomo; Wallis, Katharine; Zeller, Andreas; Gussekloo, Jacobijn; Poortvliet, Rosalinde K. E.

doi:10.1007/s11606-018-4795-x

Cited by 13 publications

(25 citation statements)

References 26 publications

(26 reference statements)

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“…15,18 Survey and interview data show that prescribers appear to consider statin discontinuation in the context of low perceived benefit (ie, primary prevention), low life expectancy, frailty, polypharmacy, and multiple comorbidities. 29,30 Consistent with this research, our findings suggest an influence of age, indication, medication use, and burden of comorbidities on discontinuation. Thus, it is possible that the discontinuation observed could at least partly reflect a purposeful and considered discontinuation process.…”

Section: Discussionsupporting

confidence: 89%

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: Discussionsupporting

confidence: 89%

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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“…In line with our study, statin use for primary prevention was also associated with a lower risk of all-cause mortality (HR 0.83; p = 0.04) compared with statin non-use in a retrospective cohort included 1370 older Korean adults (aged ≥ 75 years); this observed association was more evident (HR 0.76; p = 0.01) in case of statin use for more than 5 years [ 51 ]. However, our observational findings on all-cause mortality should be interpreted cautiously because, in clinical practice, older people with short life expectancy (e.g., with malignancy) are less likely to receive statins and this might have introduced bias into the observed results [ 52 , 53 ]. Even so, the cumulating evidence seems to be broadly consistent.…”

Section: Discussionmentioning

confidence: 99%

Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

Awad

Mohammed

Zaki

et al. 2021

BMC Med

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Background Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged > 75 years, is still lacking. We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about the association of statin use in older people primary prevention group with risk of CVD and mortality. Methods PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥ 65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model. The quality of the evidence was rated using the GRADE approach. Results Ten observational studies (9 cohorts and one case-control study; n = 815,667) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI 0.76 to 0.94]) and a non-significant association with risk of MI (HR 0.74 [95% CI 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (> 75 years old; HR 0.88 [95% CI 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR 0.85 [95% CI 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with diabetes mellitus (DM) (HR 0.82 [95% CI 0.68 to 0.98]) but not in those without DM. The level of evidence of all the primary outcomes was rated as “very low.” Conclusions Statin therapy in older people (aged ≥ 65 years) without CVD was associated with a 14%, 20%, and 15% lower risk of all-cause mortality, CVD death, and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (> 75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test the benefits of statins in those above 75 years of age.

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“…Our total sample consisted of 3,175 GPs from 31 countries who were invited to participate by email through national coordinators. Participants had previously provided consent to be contacted with opportunities to participate in future research [29,30]. Participants were eligible for inclusion if they were practicing GPs.…”

Section: Participantsmentioning

confidence: 99%

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

et al. 2021

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Background General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.

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Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

Cited by 13 publications

References 26 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

Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

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