Polypharmacy is certainly a problem in the elderly population. Forgetfulness, and drug and dose confusion can lead to multiple problems; in addition, over time, cognitive deterioration will make complicated drug management schemes even more difficult for patients to handle.
Aware of this problem, physicians often try to simplify schemes by discontinuing drugs, but what should we discontinue when it means risking patient health? This study recently presented at JAMA at least clarifies what drug NEVER to discontinue.
The study looked at a cohort of 29,047 patients older than 65 who were on statins, hypertensive medication, antidiabetics and antiplatelets between 2013 and 2015.
This study was particularly focused on patients discontinuing statins. These were matched using propensity score to be compared against patients who stayed on all medication (statins and the rest).
Of the total population of nearly 30,000 patients, 20% discontinued statins and kept taking the rest of prescribed medication; the rest of the population kept taking all drugs and served as control group.
Patients discontinuing statins had higher risk of hospitalization for cardiac failure (HR 1.24; CI 95%, 1.07-1.43), any adverse cardiovascular event (HR, 1.14; CI 95%, 1.03-1.26), all cause death (HR, 1.15; CI 95%, 1.02-1.30) and emergency hospitalization for any cause (HR, 1.12; CI 95%, 1.05-1.19).
Comorbidities rate resulted very similar in both groups, which makes it hard to believe doctors would discontinue statins because of patient frailty.
Patients receiving polypharmacy who for whatever reason discontinue statins (while still taking the rest of prescribed drugs) present increased risk of fatal and non-fatal events.
Original Title: Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy.
Reference: Federico Rea et al. JAMA Netw Open. 2021 Jun 1;4(6):e2113186. doi: 10.1001/jamanetworkopen.2021.13186.