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van der Ploeg, MA, Streit, S, Achterberg, WP, Beers, E, Bohnen, AM, Burman, RA, Collins, C, Franco, FG, Gerasimovska-Kitanovska, B, Gintere, S, Gomez Bravo, R, Hoffmann, K, Iftode, C, Peštić, SK, Koskela, TH, Kurpas, D, Maisonneuve, H, Mallen, CD, Merlo, C, Mueller, Y, Muth, C, Petrazzuoli, F, Rodondi, N, Rosemann, T, Sattler, M, Schermer, T, Šter, MP, Švadlenková, Z, Tatsioni, A, Thulesius, H, Tkachenko, V, Torzsa, P, Tsopra, R, Tuz, C, Vaes, B, Viegas, RPA, Vinker, S, Wallis, KA, Zeller, A, Gussekloo, J and Poortvliet, RKE (2019) Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries. Journal of General Internal Medicine, 34 (9). pp. 1751-1757. ISSN 1525-1497

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Abstract

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.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via Springer at https://doi.org/10.1007/s11606-018-4795-x - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: hydroxymethylglutaryl-CoA reductase inhibitors, cardiovascular diseases, drug therapy, palliative care, general practitioners, clinical decision-making
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 18 Feb 2019 10:48
Last Modified: 24 Sep 2019 08:51
URI: https://eprints.keele.ac.uk/id/eprint/5860

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