Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France

Onaisi, Racha; Dumont, Roxane; Hasselgård-Rowe, Jennifer; Safar, David; Haller, Dagmar M.; Maisonneuve, Hubert

doi:10.3389/fmed.2022.1089050

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…As an example, in the vulnerable aged population correcting vitamin D defciency may reduce its pleotropic negative efects including falls and fractures [92,[197][198][199][200]. Similarly, statin treatment may reduce risk of fractures, especially HF [154,157,201] alongside with benefcial efects on cardiovascular and CKD-related multimorbidity [202][203][204].…”

Section: Prognostic Value Of Ckd and Related Factors For Predictingmentioning

confidence: 99%

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Fisher,

Wang,

Smith

2024

International Journal of Clinical Practice

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Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.

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Section: Prognostic Value Of Ckd and Related Factors For Predictingmentioning

confidence: 99%

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Fisher,

Wang,

Smith

2024

International Journal of Clinical Practice

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Trends in statin use for the primary prevention of atherosclerotic cardiovascular disease among US adults by demographic characteristics, 1999–2020

Wang,

Ye,

Chen

et al. 2024

Eur J Clin Pharmacol

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Statins for primary prevention in multimorbid patients: to prescribe or not to prescribe? A qualitative analysis of general practitioners’ decision-making processes

Onaisi,

Bezzazi,

Berthouin

et al. 2023

Family Practice

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Introduction A better understanding of the determinants involved in general practitioners’ (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines. Methods We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs’ semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks. Results Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a “rule of thumb” process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient. Conclusion Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.

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Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France

Cited by 3 publications

References 38 publications

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Trends in statin use for the primary prevention of atherosclerotic cardiovascular disease among US adults by demographic characteristics, 1999–2020

Statins for primary prevention in multimorbid patients: to prescribe or not to prescribe? A qualitative analysis of general practitioners’ decision-making processes

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