Statin Discontinuation Low Among Older Veterans Near End of Life

Most veterans with limited life expectancy or advanced dementia do not discontinue statins after nursing home admission, according to a study published online in the Journal of the American Geriatrics Society. 

“Geriatric guidelines recommend against statin use in older adults with limited life expectancy or advanced dementia,” researchers explained. “This study examined resident and facility factors predicting statin discontinuation after nursing home admission in veterans with limited life expectancy or advanced dementia taking statins for secondary prevention.”

The retrospective investigation included 13,110 veterans age 65 and older with limited life expectancy or advanced dementia taking statins upon admission to Veterans Affairs nursing homes between 2009 and 2015.  

By day 91, just 31% of participants discontinued statins. For participants who had end-of-life status or hospice status designated at admission, the incidence of statin discontinuation by day 91 was 52%, according to the study, compared with just 25% for those without the end-of-life/hospice designation at admission. 

Among participants with end-of-life/hospice designation at admission, advanced dementia, dependency in activities of daily living, and greater number of medications predicted a higher likelihood of statin discontinuation. The likelihood was lower, however, in those with obesity, congestive heart failure, and admission from nonhospital settings. 

Among participants without end-of-life/hospice designation at admission, older age and markers of poor prognosis predicted greater likelihood of statin discontinuation. Obesity or overweight, however, predicted lower likelihood of statin discontinuation. 

“Designating residents as end-of-life status, hospice use, and individual clinical factors indicating poor prognosis may prompt deprescribing” of statins, researchers concluded. 

—Jolynn Tumolo

Reference:

Thorpe CT, Sileanu FE, Mor MK, et al. Discontinuation of Statins in Veterans Admitted to Nursing Homes near the End of Life [published online ahead of print, 2020 Aug 12]. J Am Geriatr Soc. 2020;10.1111/jgs.16727. doi:10.1111/jgs.16727