Patient-Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry

被引:176
作者
Bradley, Corey K. [1 ,2 ]
Wang, Tracy Y. [1 ,2 ]
Li, Shuang [1 ,2 ]
Robinson, Jennifer G. [3 ]
Roger, Veronique L. [4 ]
Goldberg, Anne C. [5 ]
Virani, Salim S. [6 ]
Louie, Michael J. [7 ]
Lee, L. Veronica [8 ]
Peterson, Eric D. [1 ,2 ]
Navar, Ann Marie [1 ,2 ]
机构
[1] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA
[2] Duke Univ, Sch Med, Duke Clin Res Inst, 200 Morris St, Durham, NC 27701 USA
[3] Univ Iowa, Coll Publ Hlth, Dept Epidemiol, Iowa City, IA USA
[4] Mayo Clin, Dept Internal Med, Div Cardiovasc Dis, Rochester, MN USA
[5] Washington Univ, St Louis, MO 63110 USA
[6] Baylor Coll Med, Dept Med, Houston, TX 77030 USA
[7] Regeneron Pharmaceut Inc, Global Med Affairs, 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
[8] Sanofi Pharmaceut, Bridgewater, NJ USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2019年 / 8卷 / 07期
基金
美国国家卫生研究院;
关键词
cardiovascular disease prevention; patient education/teaching; statin therapy; PROVIDER ASSESSMENT; ADHERENCE; PREDICTORS; GUIDELINE;
D O I
10.1161/JAHA.118.011765
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Many adults eligible for statin therapy for cardiovascular disease prevention are untreated. Our objective was to investigate patient-reported reasons for statin underutilization, including noninitiation, refusal, and discontinuation. Methods and Results-This study included the 5693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry. Patient surveys evaluated statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk. Overall, 1511 of 5693 adults (26.5%) were not on treatment. Of those not on a statin, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued therapy. Women (relative risk: 1.22), black adults (relative risk: 1.48), and those without insurance (relative risk: 1.38) were most likely to report never being offered a statin. Fear of side effects and perceived side effects were the most common reasons cited for declining or discontinuing a statin. Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively). Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin. Conclusions-More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor. Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered.
引用
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页数:16
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