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Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study

Milly A van der Ploeg1, Sven Streit2, Wilco P Achterberg1

  • 1Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.

Journal of General Internal Medicine
|January 18, 2019
PubMed

Insights

General practitioners (GPs) are more likely to advise stopping statins in elderly patients without a history of cardiovascular disease (CVD), with side effects, or frailty. Shortened life expectancy was the strongest factor influencing this decision.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Clinical Pharmacy

Background:

  • Statins are commonly prescribed for cardiovascular disease (CVD) prevention.
  • The risk-benefit balance of statin therapy may shift in very elderly individuals.
  • Factors influencing general practitioners' (GPs) decisions to discontinue statins in oldest-old patients remain unclear.

Purpose of the Study:

  • To examine how a history of CVD, statin side effects, frailty, and short life expectancy impact GPs' recommendations to stop statin treatment in patients over 80.
  • To identify key predictors for discontinuing statins in the oldest-old population.

Main Methods:

  • A case-based survey design was employed, involving GPs from 30 countries.
  • GPs reviewed 8 case vignettes of patients aged over 80 years on statin therapy.
  • Vignettes systematically varied factors such as CVD history, statin side effects, frailty, and shortened life expectancy (due to non-curable cancer).

Main Results:

  • A total of 2,250 GPs participated, with an overall statin cessation advice rate of 46%.
  • Advice to stop statins significantly increased with shortened life expectancy (90%), absence of CVD history (ORadj 13.8), presence of side effects (ORadj 1.62), and frailty (ORadj 4.1).
  • Shortened life expectancy emerged as the strongest predictor for advising statin cessation (ORadj 50.7), with significant international variation.

Conclusions:

  • Absence of CVD, presence of statin side effects, and frailty are independently associated with GPs' decisions to stop statins in patients over 80.
  • Shortened life expectancy, particularly in the context of advanced cancer, is the most powerful independent predictor for GPs advising statin cessation.
  • These findings highlight the complex multifactorial considerations in managing long-term statin therapy in the oldest-old population.
Abstract

Keywords:
cardiovascular diseasesclinical decision-makingdrug therapygeneral practitionershydroxymethylglutaryl-CoA reductase inhibitorspalliative care

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