Patient-Reported Reasons for Declining or Discontinuing Statin Therapy

Insights From the PALM Registry

Corey K. Bradley, Tracy Y. Wang, Shuang Li, Jennifer G. Robinson, Veronique Lee Roger, Anne C. Goldberg, Salim S. Virani, Michael J. Louie, L. Veronica Lee, Eric D. Peterson, Ann Marie Navar

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e011765
JournalJournal of the American Heart Association
Volume8
Issue number7
DOIs
StatePublished - Apr 2 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Registries
Lipids
Therapeutics
Cardiovascular Diseases

Keywords

  • cardiovascular disease prevention
  • patient education/teaching
  • statin therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Patient-Reported Reasons for Declining or Discontinuing Statin Therapy : Insights From the PALM Registry. / Bradley, Corey K.; Wang, Tracy Y.; Li, Shuang; Robinson, Jennifer G.; Roger, Veronique Lee; Goldberg, Anne C.; Virani, Salim S.; Louie, Michael J.; Lee, L. Veronica; Peterson, Eric D.; Navar, Ann Marie.

In: Journal of the American Heart Association, Vol. 8, No. 7, 02.04.2019, p. e011765.

Research output: Contribution to journalArticle

Bradley, CK, Wang, TY, Li, S, Robinson, JG, Roger, VL, Goldberg, AC, Virani, SS, Louie, MJ, Lee, LV, Peterson, ED & Navar, AM 2019, 'Patient-Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry', Journal of the American Heart Association, vol. 8, no. 7, pp. e011765. https://doi.org/10.1161/JAHA.118.011765
Bradley, Corey K. ; Wang, Tracy Y. ; Li, Shuang ; Robinson, Jennifer G. ; Roger, Veronique Lee ; Goldberg, Anne C. ; Virani, Salim S. ; Louie, Michael J. ; Lee, L. Veronica ; Peterson, Eric D. ; Navar, Ann Marie. / Patient-Reported Reasons for Declining or Discontinuing Statin Therapy : Insights From the PALM Registry. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 7. pp. e011765.
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abstract = "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.",
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AU - Bradley, Corey K.

AU - Wang, Tracy Y.

AU - Li, Shuang

AU - Robinson, Jennifer G.

AU - Roger, Veronique Lee

AU - Goldberg, Anne C.

AU - Virani, Salim S.

AU - Louie, Michael J.

AU - Lee, L. Veronica

AU - Peterson, Eric D.

AU - Navar, Ann Marie

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N2 - 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.

AB - 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.

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