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Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services

  • Maarit J. Korhonen
    Correspondence
    Corresponding author. Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520 Turku, Finland.
    Affiliations
    NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia

    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia

    Institute of Biomedicine, University of Turku, Turku, Finland
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  • Jenni Ilomäki
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia

    School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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  • Janet K. Sluggett
    Affiliations
    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia

    NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
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  • M. Alan Brookhart
    Affiliations
    Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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  • Renuka Visvanathan
    Affiliations
    NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia

    School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia

    Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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  • Tina Cooper
    Affiliations
    Resthaven Incorporated, Adelaide, South Australia, Australia
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  • Leonie Robson
    Affiliations
    Resthaven Incorporated, Adelaide, South Australia, Australia
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  • J. Simon Bell
    Affiliations
    NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia

    Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia

    School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

    NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia

    Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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Published:February 24, 2018DOI:https://doi.org/10.1016/j.jacl.2018.02.012

      Highlights

      • In aged care services, statin users had much lower mortality than nonusers.
      • Statin users had lower risks of all-cause hospitalizations and falls.
      • Channeling of statin use away from frailest residents may explain study findings.

      Background

      Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse.

      Objective

      We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up.

      Methods

      A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments.

      Results

      The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37–0.93) and hospitalizations (HR 0.67, 95% CI 0.46–0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80–2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47–0.96).

      Conclusions

      The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting.

      Keywords

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