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Nearly 60% of eligible patients never offered statin therapy
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Statin therapy was not offered to more than half of patients who were eligible for the therapy, which may potentially be associated with the concern of adverse effects, according to a study published in the Journal of the American Heart Association.
“We need to focus our efforts on improving how doctors identify patients who need to be on a statin and how they present information to patients to ensure that no one is missing the opportunity to improve their heart health,” Corey K. Bradley, MD, researcher at the Duke Clinical Research Institute, said in a press release.
Researchers analyzed data from 5,693 patients from the PALM registry who would have been recommended statin therapy based on 2013 American College of Cardiology/American Heart Association guideline. Patients in the registry completed surveys to collect information on prior statin experience, current statin utilization and beliefs on their risk for atherosclerotic CVD, trust in their health care provider and statin safety and efficacy. Lipid panels and other clinical characteristics were also assessed.
Patients were then categorized by statin use: currently on therapy (n = 4,182; mean age, 68 years; 61% men), former statin users who discontinued therapy (n = 464; mean age, 68 years; 43% men), offered therapy but declined (n = 153; mean age, 67 years; 42% men) and never offered therapy (n = 894; mean age, 68 years; 49% men).
Of the 1,511 patients not taking statins, 59.2% said they were never offered them. Patients who were most likely to report never being offered a statin included black adults (RR = 1.48; 95% CI, 1.2-1.8), women (RR = 1.22; 95% CI, 1.06-1.41) and those without insurance (RR = 1.38; 95% CI, 1.06-1.81).
The most common reason to decline or discontinue statin therapy was the fear of adverse effects (36.8%). Compared with patients who currently took statins, those who declined or discontinued statin therapy were less likely to believe that the therapy was effective (86.3% of current users; 67.4% of those who declined; and 69.1% of those who discontinued) or safe (70.4% of current users; 36.9% of those who declined; and 37.4% of those who discontinued).
The willingness to take a statin was high in patients who discontinued the therapy (59.7%) and those who were never offered statin therapy (67.7%).
“Perceptions about statin safety rather than perceptions about [atherosclerotic] CVD risk or statin benefit appear to be driving statin utilization among those who decline or discontinue therapy,” Bradley and colleagues wrote. – by Darlene Dobkowski
Disclosures: The PALM registry was funded by Sanofi and Regeneron Pharmaceuticals. Bradley reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Udho Thadani, MD, MRCP, FRCPC, FAHA, FCCS
Statins improve clinical outcomes in patients with established atherosclerotic CVD as well as in those at an increased CV risk (primary prevention). Despite these facts, statins are underused in both these patient groups.
This PALM registry report is timely in that it looked at patient-reported reasons for not taking statins. What is surprising is that nearly 16% (894 of 5,693) of patients who would have qualified for statin therapy could not recall being told to take statin therapy, and 8% recalled stopping statin due to either experiencing or perceived side effects.
Women, black adults and those without insurance were more often not on a statin. An important finding of the study was that these patients were willing to try a statin either for the first time or again.
These findings have important implications for health care providers who must set aside time to discuss the beneficial effects of statins and possible side effects with patients in greater detail and allay the patient fears when such treatment benefit outweighs the possible small side effects from statins.
There are some limitations of the study, as it was based on patient recall rather than actual documentation of facts in provider notes. Also, it is not clear if the non-statin use was greater in those for primary prevention or not. These shortcomings can be overcome by adequate dialogue between the patient and the provider and revisiting the issue after dietary and lifestyle modifications have been implemented, especially in patients where statins are indicated for primary prevention.
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