TY - JOUR
T1 - Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients
T2 - a Survey Study Across 30 Countries
AU - van der Ploeg, Milly A.
AU - Streit, Sven
AU - Achterberg, Wilco P.
AU - Beers, Erna
AU - Bohnen, Arthur M.
AU - Burman, Robert A.
AU - Collins, Claire
AU - Franco, Fabio G.
AU - Gerasimovska-Kitanovska, Biljana
AU - Gintere, Sandra
AU - Gomez Bravo, Raquel
AU - Hoffmann, Kathryn
AU - Iftode, Claudia
AU - Peštić, Sanda Kreitmayer
AU - Koskela, Tuomas H.
AU - Kurpas, Donata
AU - Maisonneuve, Hubert
AU - Mallen, Christan D.
AU - Merlo, Christoph
AU - Mueller, Yolanda
AU - Muth, Christiane
AU - Petrazzuoli, Ferdinando
AU - Rodondi, Nicolas
AU - Rosemann, Thomas
AU - Sattler, Martin
AU - Schermer, Tjard
AU - Šter, Marija Petek
AU - Švadlenková, Zuzana
AU - Tatsioni, Athina
AU - Thulesius, Hans
AU - Tkachenko, Victoria
AU - Torzsa, Péter
AU - Tsopra, Rosy
AU - Tuz, Canan
AU - Vaes, Bert
AU - Viegas, Rita P.A.
AU - Vinker, Shlomo
AU - Wallis, Katharine A.
AU - Zeller, Andreas
AU - Gussekloo, Jacobijn
AU - Poortvliet, Rosalinde K.E.
N1 - Publisher Copyright:
© 2019, The Author(s).
PY - 2019/9/15
Y1 - 2019/9/15
N2 - Background: Statins 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. 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. Design: We 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 Measures: Cases 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 Results: Two 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). Conclusions: The 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.
AB - Background: Statins 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. 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. Design: We 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 Measures: Cases 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 Results: Two 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). Conclusions: The 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.
KW - cardiovascular diseases
KW - clinical decision-making
KW - drug therapy
KW - general practitioners
KW - hydroxymethylglutaryl-CoA reductase inhibitors
KW - palliative care
UR - http://www.scopus.com/inward/record.url?scp=85060148045&partnerID=8YFLogxK
U2 - 10.1007/s11606-018-4795-x
DO - 10.1007/s11606-018-4795-x
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C2 - 30652277
AN - SCOPUS:85060148045
SN - 0884-8734
VL - 34
SP - 1751
EP - 1757
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 9
ER -
