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

Details

Serval ID
serval:BIB_F4C4F44FF6B1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries.
Journal
Journal of general internal medicine
Author(s)
van der Ploeg M.A., Streit S., Achterberg W.P., Beers E., Bohnen A.M., Burman R.A., Collins C., Franco F.G., Gerasimovska-Kitanovska B., Gintere S., Gomez Bravo R., Hoffmann K., Iftode C., Peštić S.K., Koskela T.H., Kurpas D., Maisonneuve H., Mallen C.D., Merlo C., Mueller Y., Muth C., Petrazzuoli F., Rodondi N., Rosemann T., Sattler M., Schermer T., Šter M.P., Švadlenková Z., Tatsioni A., Thulesius H., Tkachenko V., Torzsa P., Tsopra R., Tuz C., Vaes B., Viegas RPA, Vinker S., Wallis K.A., Zeller A., Gussekloo J., Poortvliet RKE
ISSN
1525-1497 (Electronic)
ISSN-L
0884-8734
Publication state
Published
Issued date
09/2019
Peer-reviewed
Oui
Volume
34
Number
9
Pages
1751-1757
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
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.
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.
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 (OR <sub>adj</sub> ) were calculated for GPs' advice to stop.
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 (OR <sub>adj</sub> 13.8, 95%CI 12.6-15.1), with side effects compared to without OR <sub>adj</sub> 1.62 (95%CI 1.5-1.7) and with frailty (OR <sub>adj</sub> 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (OR <sub>adj</sub> 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).
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.
Keywords
cardiovascular diseases, clinical decision-making, drug therapy, general practitioners, hydroxymethylglutaryl-CoA reductase inhibitors, palliative care
Pubmed
Web of science
Open Access
Yes
Create date
18/02/2019 17:37
Last modification date
16/10/2019 5:12
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