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

van der Ploeg, Milly A; Streit, Sven; Achterberg, Wilco P; Beers, Erna; Bohnen, Arthur M; Burman, Robert A; Collins, Claire; Franco, Fabio G; Gerasimovska-Kitanovska, Biljana; Gintere, Sandra; Gomez Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Peštić, Sanda Kreitmayer; Koskela, Tuomas H; Kurpas, Donata; Maisonneuve, Hubert; Mallen, Christan D; Merlo, Christoph; Mueller, Yolanda; ... (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. Springer 10.1007/s11606-018-4795-x

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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 (OR) 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 (OR 13.8, 95%CI 12.6-15.1), with side effects compared to without OR 1.62 (95%CI 1.5-1.7) and with frailty (OR 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (OR 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:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Streit, Sven and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0884-8734

Publisher:

Springer

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

23 Jan 2019 11:54

Last Modified:

25 Oct 2019 19:21

Publisher DOI:

10.1007/s11606-018-4795-x

PubMed ID:

30652277

Additional Information:

Milly A. van der Ploeg and Sven Streit contributed equally to this work.

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.124540

URI:

https://boris.unibe.ch/id/eprint/124540

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