One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins
Authors
Campitelli, Michael A.Maxwell, Colleen J.
Maclagan, Laura C.
Ko, Dennis T.
Bell, Chaim M.
Jeffs, Lianne
Morris, Andrew M.
Lapane, Kate L
Daneman, Nick
Bronskill, Susan E.
UMass Chan Affiliations
Department of Population and Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2019-01-14Keywords
geriatric medicinedrugs
statins
cardiovascular medicine
long-term care facilities
Cardiovascular Diseases
Clinical Epidemiology
Epidemiology
Geriatrics
Lipids
Therapeutics
Metadata
Show full item recordAbstract
BACKGROUND: Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting. METHODS: We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively. RESULTS: Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins. INTERPRETATION: The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.Source
CMAJ. 2019 Jan 14;191(2):E32-E39. doi: 10.1503/cmaj.180853. Link to article on publisher's site
DOI
10.1503/cmaj.180853Permanent Link to this Item
http://hdl.handle.net/20.500.14038/40949PubMed ID
30642823Related Resources
ae974a485f413a2113503eed53cd6c53
10.1503/cmaj.180853