Deprescribing Statins Viewed Positively by Patients with Life-Limiting Conditions

Patients nearing the end of their lives due to certain diseases, such as cancer, may be receptive to limiting their medications. A new study published by the Journal of Palliative Medicine found that patients near the end-of-life may not feel medically abandoned if the physician choses to take them off cholesterol medication.

These results are important since there are limited data regarding managing chronic medications for patients with life-limiting diseases. There is also little information regarding patient attitudes related to deprescribing.

Deprescribing can provide benefits to certain patients, but patient feelings about stopping statin therapy have not been explored, according to the study.

Statins inhibit the liver enzyme that control cholesterol production and reduces the buildup of plaque that can lead to stroke or heart attack. While statins are highly effective, they can cause severe side effects in some patients.

Included in the study were 300 patients with an average age of 72 whose life expectancy ranges from 1 to 12 months. Approximately 58% of patients had cancer, 8% had heart disease, and 30% had another life-limiting condition.

Patients gave responses to a questionnaire that was designed to determine the benefits and concerns regarding discontinuing statins.

"We know these patients are on a lot of medications," said researcher Jon Furuno, PhD. "There's a lot of concern that patients will feel like doctors are giving up on them if they start to discontinue some of their medications, that there's something comforting about continuing to take their medications, and this gives us some indication of what patients feel about the risks and benefits of deprescribing."

The authors found that less than 5% of patients felt deprescribing statins would make them feel abandoned by their physician, while many saw the benefits.

Approximately 63% of patients felt deprescribing could save money, 34% reported they might be able to stop additional medications, and 25% reported discontinuing statin therapy could improve overall quality of life, according to the study.

The authors also discovered that patients with cardiovascular disease were likely to see the benefits of discontinuing statin therapy, according to the study.

"Hopefully this will help inform prescribers who might be tentative to address this topic with their patients," Dr Furuno said. "As a patient's prognosis changes and we think they have a relatively short lifespan left, it really requires risk/benefit re-examination of everything we're doing for them, medications and everything else. There may still be benefits, but have the benefits changed or has the risk/benefit ratio changed?”

These results suggest that patients may be more receptive to changing medication regimens during end-of-life care than previously thought. Physicians should approach this subject with their patients to determine the best course of therapy, according to the study.

"A lot of our work is trying to better inform the evidence base for medication use at the end of life, and patient perceptions are really important in trying to honor what the patient wants and what the family wants,” Dr Furuno said.

The authors noted that patients included in the study were also participating in a study where they were randomized to go off statin, meaning that patients were at least somewhat open to the idea; however, these findings were still important, according to the study.

"So, this group is likely not completely representative of all people, because they might be foreseeing some benefits to stopping that other people hadn't considered,” Dr Furuno concluded. "But while we don't want to overlook that limitation, given the lack of information about patient perceptions regarding deprescribing, these data are important and useful as a stepping stone."