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Article Dans Une Revue Journal of General Internal Medicine Année : 2019

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

1 LUMC - Leiden University Medical Center
2 UNIBE - Universität Bern / University of Bern
3 UvA - University of Amsterdam [Amsterdam] = Universiteit van Amsterdam
4 Erasmus MC - Erasmus University Medical Center [Rotterdam]
5 Vennesla Primary Health Care Centre [Bergen]
6 ICGP - Irish College of General Practitioners [Dublin, Irlande]
7 Hospital Israelita Albert Einstein [São Paulo, Brazil]
8 UKIM - Ss. Cyril and Methodius University in Skopje
9 RSU - Riga Stradins University
10 University of Luxembourg [Luxembourg]
11 Medizinische Universität Wien = Medical University of Vienna
12 Sano Med West Private Clinic [Timisoara]
13 Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine]
14 TUT - Tampere University of Technology [Tampere]
15 Wrocław Medical University
16 UNIGE - Université de Genève = University of Geneva
17 Keele University [Keele]
18 Institute of Primary and Community Care Lucerne
19 Institute of Family Medicine Lausanne
20 Goethe University Frankfurt
21 Skane University Hospital [Lund]
22 University hospital of Zurich [Zurich]
23 SSLMG - Societé Scientifique Luxembourgois en Medicine generale [Luxembourg City]
24 University Medical Center
25 University of Ljubljana
26 Ordinace Řepy S.r.o. [Prague]
27 University of Ioannina
28 SNMAPE - Shupyk National Medical Academy of Postgraduate Education [Kiev]
29 Semmelweis University [Budapest]
30 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
31 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
32 HEGP - Hôpital Européen Georges Pompidou [APHP]
33 Erzincan University
34 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
35 NMS - NOVA Medical School - Faculdade de Ciências Médicas
36 TAU - Tel Aviv University
37 University of Auckland [Auckland]
38 Unibas - Université de Bâle = University of Basel = Basel Universität
39 Universiteit Leiden = Leiden University
Canan Tuz
  • Fonction : Auteur

Résumé

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.

Dates et versions

hal-03738848 , version 1 (26-07-2022)

Identifiants

Citer

Milly van der Ploeg, Sven Streit, Wilco Achterberg, Erna Beers, Arthur Bohnen, et al.. Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries. Journal of General Internal Medicine, 2019, 34 (9), pp.1751-1757. ⟨10.1007/s11606-018-4795-x⟩. ⟨hal-03738848⟩
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