Journal article

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

  • van der Ploeg MA Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.
  • Streit S Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
  • Achterberg WP Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.
  • Beers E Department of Family Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Bohnen AM Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.
  • Burman RA Vennesla Primary Health Care Centre, Bergen, Norway.
  • Collins C Irish College of General Practitioners, Dublin, Ireland.
  • Franco FG Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Gerasimovska-Kitanovska B Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia.
  • Gintere S Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia.
  • Gomez Bravo R Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg City, Luxembourg.
  • Hoffmann K Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
  • Iftode C Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania.
  • Peštić SK Department for Family Medicine, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina.
  • Koskela TH Department of General Practice, University of Tampere, Tampere, Finland.
  • Kurpas D Family Medicine Department, Wroclaw Medical University, Wrocław, Poland.
  • Maisonneuve H Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Mallen CD Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
  • Merlo C Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland.
  • Mueller Y Department of Community Care and Ambulatory Medicine, Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland.
  • Muth C Goethe-University, Institute of General Practice, Frankfurt/Main, Germany.
  • Petrazzuoli F Center for Primary Health Care Research, Clinical Research Center, Lund University, Malmö, Sweden.
  • Rodondi N Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
  • Rosemann T Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
  • Sattler M SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg City, Luxembourg.
  • Schermer T Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Šter MP Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
  • Švadlenková Z Ordinace Řepy, s.r.o., Prague, Prague, Czech Republic.
  • Tatsioni A Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
  • Thulesius H Department of Clinical Sciences, Section of Family Medicine, Lund University, Malmö, Sweden.
  • Tkachenko V Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
  • Torzsa P Department of Family Medicine, Semmelweis University, Budapest, Hungary.
  • Tsopra R AP-HP, Assistance Publique des Hôpitaux de Paris, Université Paris 13, Paris, France.
  • Tuz C Erzincan University Family Medicine Department, Erzincan, Turkey.
  • Vaes B Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Leuven, Belgium.
  • Viegas RPA Department of Family Medicine, NOVA Medical School, Lisbon, Portugal.
  • Vinker S Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Wallis KA Department of General Practice & Primary Health Care, School of Population Health Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
  • Zeller A Centre for Primary Health Care (uniham-bb), University of Basel, Basel, Switzerland.
  • Gussekloo J Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.
  • Poortvliet RKE Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands. R.K.E.Poortvliet@lumc.nl.
Show more…
  • 2019-01-18
Published in:
  • Journal of general internal medicine. - 2019
English 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.
Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://sonar.ch/global/documents/47102
Statistics

Document views: 40 File downloads:
  • Full-text: 0