BACKGROUND: Some have advocated discontinuing statins in patients with life-limiting conditions. However, the extent of statin use at the end of life has yet to be described and whether statin prescribing may already be influenced by the presence of a recognizable, life-limiting condition is unknown. OBJECTIVE: To measure the prevalence of statin use during the last 6 months of life and determine if statin prescribing varies according to the presence of a recognizable, life-limiting condition. DESIGN: Matched, case-control trial nested within a retrospective, cohort study. SETTING/ SUBJECTS: From 3031 VISN 11 patients who died in FY2004, we identified 1584 (52%) receiving statins at least 6 months before death. Of those, we identified 337 cases with a recognizable, life-limiting condition and 1247 controls matched on number of comorbidities, age, and socioeconomic status. ANALYSES: We used survival analysis to test the relationship between days without statins and the presence of a life limiting condition, while controlling for pills supplied and comorbidity score. RESULTS: There was no significant difference in the time off statins between cases and controls even though the study was sufficiently powered to detect one. CONCLUSIONS: These findings underscore a missed opportunity to reduce the therapeutic burden upon dying patients and limit health care spending.
BACKGROUND: Some have advocated discontinuing statins in patients with life-limiting conditions. However, the extent of statin use at the end of life has yet to be described and whether statin prescribing may already be influenced by the presence of a recognizable, life-limiting condition is unknown. OBJECTIVE: To measure the prevalence of statin use during the last 6 months of life and determine if statin prescribing varies according to the presence of a recognizable, life-limiting condition. DESIGN: Matched, case-control trial nested within a retrospective, cohort study. SETTING/ SUBJECTS: From 3031 VISN 11 patients who died in FY2004, we identified 1584 (52%) receiving statins at least 6 months before death. Of those, we identified 337 cases with a recognizable, life-limiting condition and 1247 controls matched on number of comorbidities, age, and socioeconomic status. ANALYSES: We used survival analysis to test the relationship between days without statins and the presence of a life limiting condition, while controlling for pills supplied and comorbidity score. RESULTS: There was no significant difference in the time off statins between cases and controls even though the study was sufficiently powered to detect one. CONCLUSIONS: These findings underscore a missed opportunity to reduce the therapeutic burden upon dying patients and limit health care spending.
Authors: Jennifer Tjia; Sarah L Cutrona; Daniel Peterson; George Reed; Susan E Andrade; Susan L Mitchell Journal: J Am Geriatr Soc Date: 2014-11-04 Impact factor: 5.562
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