Discontinuing Cardiovascular Medications at the End of Life: Lipid-Lowering Agents

Vollrath, Annette M.; Sinclair, Christian T.; Hallenbeck, James

doi:10.1089/jpm.2005.8.876

Cited by 46 publications

(42 citation statements)

References 33 publications

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“…Moreover, although statins usually have a good safety profile, they may interact with other drugs, are expensive, and can result in rare but serious side effects such as hepatitis and rhabdomyolysis [20]. A systematic review on the use of lipid-lowering drugs by noncancer patients at the end of life discussed the burden of long-term use of statins to patients and the complexities of discontinuing medications that do not necessarily impact on patient quality of life or survival [21]. Although multivitamins usually do not cause adverse clinical consequences, they may interact with other drugs [22] and can be costly; these likely reflect patient self-prescription.…”

Section: Discussionmentioning

confidence: 99%

Futile medication use in terminally ill cancer patients

Riechelmann

Krzyzanowska

Zimmermann

2008

Support Care Cancer

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Section: Discussionmentioning

confidence: 99%

Futile medication use in terminally ill cancer patients

Riechelmann

Krzyzanowska

Zimmermann

2008

Support Care Cancer

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“…5 Thus, possible benefits of statin use at the end of life include prevention of acute cardiovascular events, but these benefits may be limited to persons at high risk. [5][6][7] Further, patients and families may have personal preferences to either continue or discontinue treatment. Risks of statin continuation include medication side effects arising from changes in drug metabolism, medication burden for patients and caregivers, and misallocation of health care resources.…”

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confidence: 99%

“…Risks of statin continuation include medication side effects arising from changes in drug metabolism, medication burden for patients and caregivers, and misallocation of health care resources. 7,8 Previous investigations have described persistent rather than attenuated statin use at the end of life; however, optimal statin management is unclear. [9][10][11][12] We explored statin prescribing patterns in a cohort of 539 persons with an incident cancer diagnosis with a relatively poor prognosis (0% to 25% predicted 5-year survival) who were receiving statins at the time of diagnosis.…”

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confidence: 99%

Statin Prescribing Patterns in a Cohort of Cancer Patients with Poor Prognosis

Bayliss

Bronsert²,

Reifler

et al. 2013

Journal of Palliative Medicine

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Background: There are no evidence-based recommendations for statin continuation or discontinuation near the end of life. However, some expert opinion recommends continuing statins prescribed for secondary versus primary prevention of cardiovascular disease. Objectives: Our aim was to explore statin prescribing patterns in a longitudinal cohort of individuals with lifelimiting illness, and to evaluate differences in these patterns based on secondary versus primary prevention of cardiovascular disease. Design and setting: This study was a retrospective cohort analysis of 539 persons in an integrated, not-for-profit health maintenance organization (HMO) setting who were receiving statins at diagnosis of a cancer with 0% to 25% predicted 5-year survival. Of the cohort patients, 343 were taking statins for secondary prevention and 196 for primary prevention of cardiovascular disease. Measurements included number and timing of statin refills between diagnosis and date of death, disenrollment, or the end of the observation period. Results: Four hundred and ninety-six cohort members died within the observation period. Fifty-eight percent of the secondary prevention and 62% of the primary prevention group had at least one statin refill after diagnosis. There were no significant differences between groups for number of days between diagnosis and last refill, or between last refill and death. Two deaths were attributable to cardiovascular causes in each group. Conclusions: Our retrospective cohort analysis of persons with incident poor-prognosis cancer describes diminished, but persistent statin refills after diagnosis. Neither timing of statin discontinuation nor cardiovascular mortality differed by prescribing indication. There may be an opportunity to reevaluate medication burden in persons taking statins for primary prevention, and it is unclear whether continuing statins prescribed for secondary prevention affects cardiovascular outcomes.

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“…40 The effect of statin discontinuation on other outcomes important in palliative care, such as patient burden, quality of life, and performance status, is also unclear. Although an enlarging literature, predominantly in palliative care journals, supports discontinuation of medications, specifically statins, in end-stage disease, 41 the balance of medication efficacy versus burden has yet to be defined in clinical studies.…”

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confidence: 99%

A Strategy To Advance the Evidence Base in Palliative Medicine: Formation of a Palliative Care Research Cooperative Group

Abernethy

Aziz

Basch

et al. 2010

Journal of Palliative Medicine

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Background: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. Methods: A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care. Results: The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success.

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Discontinuing Cardiovascular Medications at the End of Life: Lipid-Lowering Agents

Cited by 46 publications

References 33 publications

Futile medication use in terminally ill cancer patients

Futile medication use in terminally ill cancer patients

Statin Prescribing Patterns in a Cohort of Cancer Patients with Poor Prognosis

A Strategy To Advance the Evidence Base in Palliative Medicine: Formation of a Palliative Care Research Cooperative Group

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