Jennifer Tjia1, Jean S Kutner2, Christine S Ritchie3, Patrick J Blatchford4, Rachael E Bennett Kendrick5, Maryjo Prince-Paul6, Tamara J Somers7, Mary Lynn McPherson8, Jeff A Sloan9, Amy P Abernethy10, Jon P Furuno11. 1. 1 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts. 2. 2 Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado. 3. 3 Department of Medicine, University of California San Francisco School of Medicine , San Francisco, California. 4. 4 Department of Biostatistics and Informatics, University of Colorado School of Medicine , Aurora, Colorado. 5. 5 Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado. 6. 6 Frances Payne Bolton School of Nursing, Case Western Reserve University , Cleveland, Ohio. 7. 7 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, North Carolina. 8. 8 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore, Maryland. 9. 9 Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota. 10. 10 Flatiron Health , New York, New York. 11. 11 Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy , Portland, Oregon.
Abstract
BACKGROUND: Optimal management of chronic medications for patients with life-limiting illness is uncertain. Medication deprescribing may improve outcomes in this population, but patient concerns regarding deprescribing are unclear. OBJECTIVE: The aim of this study was to quantify the perceived benefits and concerns of statin discontinuation among patients with life-limiting illness. DESIGN: Baseline data from a multicenter, pragmatic clinical trial of statin discontinuation were used. SETTING/ SUBJECTS: Cognitively intact participants with a life expectancy of 1-12 months receiving statin medications for primary or secondary prevention were enrolled. MEASUREMENTS: Responses to a 9-item questionnaire addressing patient concerns about discontinuing statins were collected. We used Pearson chi-square tests to compare responses by primary life-limiting diagnosis (cancer, cardiovascular disease, other). RESULTS: Of 297 eligible participants, 58% had cancer, 8% had cardiovascular disease, and 30% other primary diagnoses. Mean (standard deviation) age was 72 (11) years. Fewer than 5% of participants expressed concern that statin deprescribing indicated physician abandonment. About one in five participants reported being told to take statins for the rest of their life (18%) or feeling that discontinuation represented prior wasted effort (18%). Many participants reported benefits of stopping statins, including spending less money on medications (63%), potentially stopping other medications (34%), and having a better quality of life (25%). More participants with cardiovascular disease as a primary diagnosis perceived that quality-of-life benefits related to statin discontinuation (52%) than participants with cancer (27%) or noncardiovascular disease diagnoses (27%) [p = 0.034]. CONCLUSION: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cardiovascular disease patients perceived greater potential positive impact from statin discontinuation.
BACKGROUND: Optimal management of chronic medications for patients with life-limiting illness is uncertain. Medication deprescribing may improve outcomes in this population, but patient concerns regarding deprescribing are unclear. OBJECTIVE: The aim of this study was to quantify the perceived benefits and concerns of statin discontinuation among patients with life-limiting illness. DESIGN: Baseline data from a multicenter, pragmatic clinical trial of statin discontinuation were used. SETTING/ SUBJECTS: Cognitively intact participants with a life expectancy of 1-12 months receiving statin medications for primary or secondary prevention were enrolled. MEASUREMENTS: Responses to a 9-item questionnaire addressing patient concerns about discontinuing statins were collected. We used Pearson chi-square tests to compare responses by primary life-limiting diagnosis (cancer, cardiovascular disease, other). RESULTS: Of 297 eligible participants, 58% had cancer, 8% had cardiovascular disease, and 30% other primary diagnoses. Mean (standard deviation) age was 72 (11) years. Fewer than 5% of participants expressed concern that statin deprescribing indicated physician abandonment. About one in five participants reported being told to take statins for the rest of their life (18%) or feeling that discontinuation represented prior wasted effort (18%). Many participants reported benefits of stopping statins, including spending less money on medications (63%), potentially stopping other medications (34%), and having a better quality of life (25%). More participants with cardiovascular disease as a primary diagnosis perceived that quality-of-life benefits related to statin discontinuation (52%) than participants with cancer (27%) or noncardiovascular disease diagnoses (27%) [p = 0.034]. CONCLUSION: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cardiovascular diseasepatients perceived greater potential positive impact from statin discontinuation.
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