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

Milly A van der Ploeg, Sven Streit, Wilco P Achterberg, Erna Beers, Arthur M Bohnen, Robert A Burman, Claire Collins, Fabio G Franco, Biljana Gerasimovska-Kitanovska, Sandra Gintere, Raquel Gomez Bravo, Kathryn Hoffmann, Claudia Iftode, Sanda Kreitmayer Peštić, Tuomas H Koskela, Donata Kurpas, Hubert Maisonneuve, Christan D Mallen, Christoph Merlo, Yolanda Mueller, Christiane Muth, Ferdinando Petrazzuoli, Nicolas Rodondi, Thomas Rosemann, Martin Sattler, Tjard Schermer, Marija Petek Šter, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Péter Torzsa, Rosy Tsopra, Canan Tuz, Bert Vaes, Rita P A Viegas, Shlomo Vinker, Katharine A Wallis, Andreas Zeller, Jacobijn Gussekloo, Rosalinde K E Poortvliet, Milly A van der Ploeg, Sven Streit, Wilco P Achterberg, Erna Beers, Arthur M Bohnen, Robert A Burman, Claire Collins, Fabio G Franco, Biljana Gerasimovska-Kitanovska, Sandra Gintere, Raquel Gomez Bravo, Kathryn Hoffmann, Claudia Iftode, Sanda Kreitmayer Peštić, Tuomas H Koskela, Donata Kurpas, Hubert Maisonneuve, Christan D Mallen, Christoph Merlo, Yolanda Mueller, Christiane Muth, Ferdinando Petrazzuoli, Nicolas Rodondi, Thomas Rosemann, Martin Sattler, Tjard Schermer, Marija Petek Šter, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Péter Torzsa, Rosy Tsopra, Canan Tuz, Bert Vaes, Rita P A Viegas, Shlomo Vinker, Katharine A Wallis, Andreas Zeller, Jacobijn Gussekloo, Rosalinde K E Poortvliet

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.

Keywords: cardiovascular diseases; clinical decision-making; drug therapy; general practitioners; hydroxymethylglutaryl-CoA reductase inhibitors; palliative care.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Reasons for GPs to stop statin treatment in patients over 80 years. The light grey coloured bars represent the proportion of GPs that consider this reason to advise to stop statins in patients over 80 years (multiple reasons could be selected). The black coloured bars represent the proportion of GPs that indicated this reason as the most important reason. Asterisk means life expectancy less than 3 months.

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