Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry
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 adult...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011765 |
| _version_ | 1819178194985549824 |
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| author | Corey K. Bradley Tracy Y. Wang Shuang Li Jennifer G. Robinson Veronique L. Roger Anne C. Goldberg Salim S. Virani Michael J. Louie L. Veronica Lee Eric D. Peterson Ann Marie Navar |
| author_facet | Corey K. Bradley Tracy Y. Wang Shuang Li Jennifer G. Robinson Veronique L. Roger Anne C. Goldberg Salim S. Virani Michael J. Louie L. Veronica Lee Eric D. Peterson Ann Marie Navar |
| author_sort | Corey K. Bradley |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T21:38:41Z |
| format | Article |
| id | doaj.art-917e1cf457024c9fa81017edd8998aaf |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:38:41Z |
| publishDate | 2019-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-917e1cf457024c9fa81017edd8998aaf2022-12-21T18:11:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-04-018710.1161/JAHA.118.011765Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM RegistryCorey K. Bradley0Tracy Y. Wang1Shuang Li2Jennifer G. Robinson3Veronique L. Roger4Anne C. Goldberg5Salim S. Virani6Michael J. Louie7L. Veronica Lee8Eric D. Peterson9Ann Marie Navar10Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NCDepartment of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NCDepartment of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NCDepartment of Epidemiology College of Public Health University of Iowa Iowa City IADepartment of Internal Medicine Division of Cardiovascular Diseases Mayo Clinic Rochester MNWashington University St Louis MODepartment of Medicine Baylor College of Medicine Houston TXGlobal Medical Affairs Regeneron Pharmaceuticals, Inc. Tarrytown NYSanofi Pharmaceuticals Bridgewater NJDepartment of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NCDepartment of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NCBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.118.011765cardiovascular disease preventionpatient education/teachingstatin therapy |
| spellingShingle | Corey K. Bradley Tracy Y. Wang Shuang Li Jennifer G. Robinson Veronique L. Roger Anne C. Goldberg Salim S. Virani Michael J. Louie L. Veronica Lee Eric D. Peterson Ann Marie Navar Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease prevention patient education/teaching statin therapy |
| title | Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry |
| title_full | Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry |
| title_fullStr | Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry |
| title_full_unstemmed | Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry |
| title_short | Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry |
| title_sort | patient reported reasons for declining or discontinuing statin therapy insights from the palm registry |
| topic | cardiovascular disease prevention patient education/teaching statin therapy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011765 |
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