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Nearly half of older patients stop taking statins within a year, study finds

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4700 (Published 07 November 2018) Cite this as: BMJ 2018;363:k4700
  1. Susan Mayor
  1. London, UK

Nearly half of older patients prescribed statins stop taking them within a year, a large observational study1 has found.

Researchers analysed data for all adults aged 65 years and older who were dispensed at least one prescription for a statin over the two year period from 1 January 2014 to 31 December 2015. The data came from the Pharmaceutical Benefits Scheme, which collects information on the type, quantity, and timing of drugs dispensed to a randomly selected 10% sample of the Australian population covered by the country’s universal healthcare scheme.

Results, published in the British Journal of Clinical Pharmacology, showed that 44.7% of the 22 340 patients (mean age 73.1 years) discontinued statins within one year of their initial prescription.

The discontinuation rate was higher in patients making lower co-payments for their prescriptions (50.4% of 17 499 patients) than those making higher co-payments (43.1% of 4841 patients).

Just over half (55.1%) of the patients in the study were nonadherent with statins, which was defined as taking less than 80% of prescribed doses during the one year of follow-up.

The risks of both discontinuation and nonadherence with statins increased with age and comorbid diabetes and were higher when GPs initiated treatment. Patients with lower co-payments aged 75 to 84 years had an 11% higher likelihood of discontinuation compared with those aged 65 to 74 years (odds ratio [OR] 1.11; 95% confidence interval [CI], 1.04 to 1.19) while those aged 85 and older had a 38% higher risk of stopping statins (OR 1.38; 95% CI, 1.23 to 1.54).

Patients with diabetes in the lower co-payment group were 14% more likely to discontinue statins compared with those without (OR 1.14; 95% CI, 1.05 to 1.23). And the odds of discontinuation were 36% greater where statins initiated by a GP rather than a hospital specialist (OR 1.36; 95% CI; 1.27 to 1.46).

Having anxiety or a pain disorder was also associated with a higher likelihood of discontinuing statins.

“The study findings highlight the need for interventions to improve statin use among older adults—in order that the benefits of statins can be realised—and recognition that certain subgroups of people may require additional attention,” said senior author Danny Liew, chair of clinical outcomes research at Monash University, Melbourne, Australia.

The researchers acknowledged that study limitations included not stratifying results according to statin indication and failing to determine whether people who stopped their statin restarted at a later date.

However, they concluded, “Greater insight into the determinants of statin nonadherence and discontinuation is important because both are associated with poor clinical outcomes.” They added, “Certain subgroups, such as those aged 85 and older and people with diabetes or anxiety, may need more attention to improve adherence.”

The study was funded by the National Health and Medical Research Council fellowships and Monash scholarships.

References

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