Abstract
BackgroundStatins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners’ (GPs) advice to stop statins in oldest-old patients.ObjectiveTo investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs’ advice to stop statins in oldest-old patients.DesignWe invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment.Main MeasuresCases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs’ advice to stop.Key ResultsTwo thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45–47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89–90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6–15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5–1.7) and with frailty (ORadj 4.1, 95%CI 3.8–4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5–56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19–42) to 98% (95% CI 96–99).ConclusionsThe absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs’ advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs’ advice to stop statins.
Highlights
Cholesterol-lowering treatment with statins is an important part of cardiovascular risk management
Recent research on general practitioners’ (GPs) decision-making on primary prevention of cardiovascular disease (CVD) suggests that, while some GPs follow guidelines regardless of patient age, other GPs take into consideration patient factors including comorbidities, frailty and estimated life expectancy.[4]
See Appendix 2 for the results per country. In this international survey of more than 2200 GPs from 30 countries, we investigated how patient characteristics influence GP advice to stop statin treatment in patients 80 years and over
Summary
Cholesterol-lowering treatment with statins is an important part of cardiovascular risk management. The lack of information about the risk-to-benefit ratio of preventive treatment for older patients makes it challenging for GPs to advise on statin therapy.[4, 5] Guidelines generally do not include recommendations when to stop statin treatment (other than in the presence of adverse events).[6,7,8,9] Statins have been identified as in need of evidence-based deprescribing guidelines.[10] Recent research on GP decision-making on primary prevention of cardiovascular disease (CVD) suggests that, while some GPs follow guidelines regardless of patient age, other GPs take into consideration patient factors including comorbidities, frailty and estimated life expectancy.[4] It is unclear how patient factors influence GPs’ advice on when to stop statin treatment in older patients. The risks of statins might outweigh the potential benefits It is unclear which factors influence general practitioners’ (GPs) advice to stop statins in oldestold patients. OBJECTIVE: To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs’ advice to stop statins in oldest-old patients.
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