Perceptions of Statin Discontinuation among Patients with Life-Limiting Illness

Abstract

Background: Optimal management of chronic medications for patients with life-limiting illness is uncertain. Medication deprescribing may improve outcomes in this population, but patient concerns regarding deprescribing are unclear.

Objective: The aim of this study was to quantify the perceived benefits and concerns of statin discontinuation among patients with life-limiting illness.

Design: Baseline data from a multicenter, pragmatic clinical trial of statin discontinuation were used.

Setting/subjects: Cognitively intact participants with a life expectancy of 1-12 months receiving statin medications for primary or secondary prevention were enrolled.

Measurements: Responses to a 9-item questionnaire addressing patient concerns about discontinuing statins were collected. We used Pearson chi-square tests to compare responses by primary life-limiting diagnosis (cancer, cardiovascular disease, other).

Results: Of 297 eligible participants, 58% had cancer, 8% had cardiovascular disease, and 30% other primary diagnoses. Mean (standard deviation) age was 72 (11) years. Fewer than 5% of participants expressed concern that statin deprescribing indicated physician abandonment. About one in five participants reported being told to take statins for the rest of their life (18%) or feeling that discontinuation represented prior wasted effort (18%). Many participants reported benefits of stopping statins, including spending less money on medications (63%), potentially stopping other medications (34%), and having a better quality of life (25%). More participants with cardiovascular disease as a primary diagnosis perceived that quality-of-life benefits related to statin discontinuation (52%) than participants with cancer (27%) or noncardiovascular disease diagnoses (27%) [p = 0.034].

Conclusion: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cardiovascular disease patients perceived greater potential positive impact from statin discontinuation.

Keywords: deprescribing; medication discontinuation; statins.

Conflict of interest statement

J. T. is a paid consultant for CVS Caremark. She also serves as a consultant to the Massachusetts Board of Registration in Medicine. J.S.K, P.J.B, R.E.B., M.P.P., T.J.S., M.L.M., and J.A.S. have nothing to disclose. C.S.R. serves as an Editor for UpToDate. A.P.A. is Chief Medical Officer and Senior Vice President of oncology at Flatiron Health. J.P.F. is a paid consultant and has received research funding and speaking honoraria from Merck & Co.