4CPS-036 Statins and the elderly: is their use appropriate?. (2nd March 2018)

• Record Type: Journal Article
• Authors: Marguet, H; Demelier, A; Diallo, A; Gervais, R
• Is Part Of: European journal of hospital pharmacy. Volume 25(2018)Supplement 1
• Page Start: A57
• Page End: A58
• Publication Date: 2018-03-02
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2018-eahpconf.127
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background: Statins are widely prescribed to the elderly in primary prevention (PP) and secondary prevention (SP) of cardiovascular diseases, although data on the benefits of this therapeutic class in patients over 65 years remain rare. They are not harmless because of their serious side-effects, and drug interaction, especially to polymedicated patients. Purpose: This study was designed to evaluate statin prescriptions in our hospital. Material and methods: This observational study was performed from June to September 2017 in geriatric units. Inclusion criteria were: age over 65 years and statin prescription. Data collected were: cardiovascular risk factors; age at statin introduction; dosage; indication; side-effects' occurrence; and side-effects' risk factors. Results: In our study, 86 patients were included, with 2.3 [1–4] cardiovascular risk factors per patient. Median age was 83 years (66–98). Statins were prescribed in PP for 34 patients and in SP for 52 (40 after stroke, 12 after myocardial infarction). Statins introduction in patients over 80 years' old represented 23% of patients (five in PP, 15 in SP). We reported eight cases of side-effects: one hepatic cytolysis, six falls and one fainting fit leading to rhabdomyolysis increased by statins. For those patients, one treatment was discontinued definitively and three temporarily, two had a reduction in dosage and two had no modification. According to current recommendations (French Medicine Agency, European Society of Cardiology), statins in PP could be re-evaluated in 28 patients (82. 4%): three statins' introduction in patients over 80 years' old, one with low cardiovascular risk factor (i.e. only one), 17 with important non-cardiovascular comorbidities (i.e. at least three), two with side-effects and five with several of these criteria combined. Besides, statins in SP could be re-evaluated in 53 patients (100%): 23 with low-life expectancy (90 years old' and above), 24 with low-life expectancy and important comorbidities, three with low-life expectancy and side-effects, and three with several criteria. Conclusion: This study leads to a reconsideration of the use of statins in patients over 80 years' old in order to limit iatrogenic risks. We will propose prescribers to re-evaluate treatment when it is not appropriate. Further studies could allow the definition of precise limits in the use of statins in patients over 80 years' old and to create a score to guide the decision. No conflict of interest