Discontinuing Statins in Palliative Care Patients | Journal Scan

Apr 08, 2015
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Authors:
Kutner JS, Blatchford PJ, Taylor DH, et al.
Citation:
Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial. JAMA Intern Med 2015;Mar 23:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

What is the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting?

Methods:

This was a multicenter, randomized, unblinded, pragmatic clinical trial of adults with an estimated life expectancy of between 1 month and 1 year, who were on statin therapy for 3 months or more, and had no recent active cardiovascular disease (CVD). Participants were randomized to either discontinue or continue statin therapy with the analysis by intention-to-treat. Outcomes included death within 60 days (primary outcome), survival, CV events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings.

Results:

A total of 381 patients were enrolled; 189 were randomized to abruptly discontinue statins, and 192 were randomized to continue therapy. Median follow-up was 18 weeks. Mean age was 74.1 (11.6) years, 22% were cognitively impaired, 58% had CVD, and 48.8% had cancer. There was no difference between groups for death within 60 days (23.8% vs. 20.3%, p = 0.36). Total QOL was better for the group discontinuing statins (mean McGill QOL score, 7.11 vs. 6.85; p = 0.04). Less than 5% experienced CV events in both groups. Mean cost savings were $3.37 per day and $716 per patient.

Conclusions:

This pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs.

Perspective:

This well-designed trial provides the clinician with good support for recommending abruptly stopping statins in both the palliative care and hospice setting.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Geriatric Cardiology, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Cardiovascular Diseases, Geriatrics, Cost Savings, Death, Drug Costs, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Intention to Treat Analysis, Life Expectancy, Neoplasms, Palliative Care, Quality of Life, Secondary Prevention, Survival


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