Underuse of statins among older people

Wilde, Stephen De; Cook, Derek G; Carey, Iain M.; Hilton, SR; Whincup, Peter H.

doi:10.1016/s0140-6736(03)14216-x

Cited by 10 publications

(11 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, a concerning finding in this study was the number of patients with elevated TC levels who were not on statin therapy. Although a number of guidelines have been published supporting the effectiveness of statins in reducing the risk of cardiovascular events, high variability in the prescription of such drugs has been reported in elderly people [35,36]. Indeed, only one fourth of patients who are eligible for statin therapy received it, and numbers are particularly low among individuals >75 years old [35,36].…”

Section: Discussionmentioning

confidence: 99%

“…The undertreatment of high TC levels in elderly persons can be attributed to a number of possible causes. First, in some studies the predictive value of cholesterol has been shown to decline with increasing age [35,36]. Second, statin treatment may be perceived as unlikely to benefit older patients because of their theoretical shortlife expectancy [35,36].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke

Cataldo

Calcara

Caputo

et al. 2012

Disability and Health Journal

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of total serum cholesterol with functional outcome following home care rehabilitation in Italian patients with stroke

Cataldo

Calcara

Caputo

et al. 2012

Disability and Health Journal

View full text Add to dashboard Cite

show abstract

“…Accordingly, physicians should be most enthusiastic and assiduous about the use of evidence-based therapies in high-risk patients who have the most to gain. This has not been the case for many therapies, where an inverse relationship between baseline risk and application of treatment has been shown (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). For example, in the cardiovascular field, elderly patients, patients with lower socioeconomic status and those with greater comorbidity undergo fewer cardiac interventions and may be less likely to receive beta-blockers, acetylsalicylic acid and statins following acute myocardial infarction (AMI), even though these patients have the most to gain (3,4,(6)(7)(8)(9)(10)14).…”

mentioning

confidence: 99%

Clinical prognosis, pre-existing conditions and the use of reperfusion therapy for patients with ST segment elevation acute myocardial infarction

Parker

Naylor

Chong

et al. 2006

Canadian Journal of Cardiology

View full text Add to dashboard Cite

BACKGROUND: Some evidence-based therapies are underused in patients with a poor prognosis despite the fact that the survival gains would be highest among such patient subgroups. The extent to which this applies for acute, life-saving therapies is unknown. The impact of prognostic characteristics and pre-existing conditions on the use of reperfusion therapy among eligible patients with acute ST segment elevation myocardial infarction is examined. METHODS: Of 2829 acute myocardial infarction patients prospectively identified in 53 acute care hospitals across Ontario, 987 presented with ST segment elevation within 12 h of symptom onset and without any absolute contraindications to reperfusion therapy. The baseline prognosis for each patient was derived from a validated riskadjustment model of 30-day mortality. Multiple logistical regression was used to examine the relationships among reperfusion therapy, prognosis and the number of pre-existing chronic conditions after adjusting for factors such as age, sex, time since symptom onset and socioeconomic status. RESULTS: Of the 987 appropriate candidates, 725 (73.5%) received reperfusion therapy (70.8% fibrinolysis, 2.6% primary angioplasty). The adjusted odds ratio of reperfusion therapy fell 4% with each 1% increase in baseline risk of death (adjusted OR 0.96, 95% CI 0.92 to 1.00, P=0.04) and fell 18% with each additional pre-existing condition (adjusted OR 0.82, 95% CI 0.76 to 0.90, P<0.001). The number rather than the type of pre-existing conditions inversely correlated with the use of reperfusion therapy. While the impact of baseline risk and pre-existing conditions was additive, pre-existing conditions exerted a greater impact on the nonuse of reperfusion therapy than did baseline risk. CONCLUSIONS: A treatment-risk paradox is demonstrable even within a cohort of lower risk patients with ST segment elevation myocardial infarction. These findings are consistent with the view that these clinical decisions are more likely to be attributable to concerns about patient frailty or side effects than to a misunderstanding of treatment benefits.

show abstract

“…39,40 Secondary prevention of CHD in older patients might be viewed as a futile effort by some clinicians, in light of these patients' frailty and more limited life span. 41,42 Regarding gender, previous studies have suggested that men are more likely to receive a statin than women, but the difference disappears once age differences and other factors are controlled. 15,41 In contrast, our findings show a gender bias regarding initiation of statin therapy after discharge from CHD hospitalization after adjustment for other factors.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…41,42 Regarding gender, previous studies have suggested that men are more likely to receive a statin than women, but the difference disappears once age differences and other factors are controlled. 15,41 In contrast, our findings show a gender bias regarding initiation of statin therapy after discharge from CHD hospitalization after adjustment for other factors. The discrepancy with previous literature might be because of the difference in study populations.…”

Section: ■■ Discussionmentioning

confidence: 99%