Prevalent Statin Use in Long‐Stay Nursing Home Residents with Life‐Limiting Illness

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 68; no. 4; pp. 708 - 716
• Main Authors: Mack, Deborah S., Tjia, Jennifer, Hume, Anne L., Lapane, Kate L.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.04.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Arteriosclerosis; Cardiovascular diseases; Cholesterol; Chronic Disease - drug therapy; Chronic Disease - epidemiology; Cross-Sectional Studies; Drug therapy; Drug Utilization - statistics & numerical data; end of life; Female; Homes for the Aged - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Illnesses; Low density lipoprotein; Male; Medicare; Nursing homes; Nursing Homes - statistics & numerical data; Palliative Care - methods; pharmacotherapy; Polypharmacy; Prognosis; Risk factors; Statins; Terminal illnesses; United States - epidemiology; United States; end of life; pharmacotherapy; statins; nursing homes
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16336

OBJECTIVES To evaluate the prevalence and factors associated with statin pharmacotherapy in long‐stay nursing home residents with life‐limiting illness. DESIGN Cross‐sectional. SETTING US Medicare‐ and Medicaid‐certified nursing home facilities. PARTICIPANTS Long‐stay nursing home resident Medicare fee‐for‐service beneficiaries aged 65 years or older with life‐limiting illness (n = 424 212). MEASUREMENTS Prevalent statin use was estimated as any low‐moderate intensity (daily dose low‐density lipoprotein‐cholesterol [LDL‐C] reduction <30%‐50%) and high‐intensity (daily dose LDL‐C reduction >50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90‐day look‐back period. Life‐limiting illness was operationally defined to capture those near the end of life using evidence‐based criteria to identify progressive terminal conditions or limited prognoses (<6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors. RESULTS A total of 34% of residents with life‐limiting illness were prescribed statins (65‐75 y = 44.0%, high intensity = 11.1%; >75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life‐limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors. CONCLUSION Despite having a life‐limiting illness, more than one‐third of clinically compromised long‐stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted. J Am Geriatr Soc 68:708–716, 2020 See related editorial by Joseph G. Ouslander in this issue.