Background: Statins are widely used to prevent cardiovascular disease (CVD). Current guidelines give little advice on when to stop statin treatment. GPs must rely on other factors like patient characteristics or common practice when making treatment decisions.
Research questions: Do patient-related characteristics (frailty, statin-related side effects, history of CVD or limited life expectancy) influence GPs’ advice to stop statins in the oldest old (>80 years)? Does advice vary across countries?
Methods: GPs from 30 countries (27 in Europe, Brazil, Israel, and New Zealand) participated in a survey based on case vignettes. We compared treatment advice in cases of >80 years varying in frailty, statin-related side effects, history of CVD and life expectancy <1 year. We compared the percentage of cases per GP that would be advised to stop. We used mixed-effect models to calculate odd ratio’s (ORsadj) adjusted for GP characteristics (such as gender) as fixed effects; country and GPs were adjusted as random effects.
Results: n = 2250. When no information about life expectancy was given, GPs advised stopping statin treatment in 46% of the cases (range: 23–58% across countries). When ‘life expectancy <1 year’ was added to case descriptions, GPs advised stopping statins in an additional 82% of the cases (range: 30–98% across countries). Frailty, side effects and life expectancy were associated with increased advice to stop (ORadj: 4.1; 95%CI: 3.8–4.4; ORadj: 1.62; 95%CI: 1.5–1.7 ORadj: 50.7; 95%CI: 45.5–56.4, respectively), while history of CVD was strongly related with decreased advice to stop (ORadj: 0.07; 95%CI: 0.07–0.08).
Conclusion: GPs were more likely to advise stopping statin treatment in >80 year-old patients when patients were frail, suffering statin side effects or had limited life expectancy; and more likely to continue statin treatment as secondary prevention for CVD. There were considerable treatment variations across countries.