(156) Patterns of Statin Use in Oldest Old in Quebec, Canada, 2008-2018

Publication Number: 830

Background: Statins are one of the most widely used therapeutic classes in older adults. Nonetheless, there is very limited evidence-based data on the benefits and risks of statins for the population aged ≥75 years, especially in primary prevention. The population-based patterns of prescription and discontinuation of statins in oldest old are not well described.

Objectives: The objective was to draw a portrait of statin prescription and discontinuation among community dwelling, oldest old adults in Quebec, Canada, between 2008 and 2018.

Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we built a population-based cohort of all individuals ≥80 years on April 1, 2013. To be included, individuals had to live in the community and be covered with the provincial drug plan between April 1, 2008, and April 1, 2013. We studied their use of statins from April 1, 2008, to March 31, 2018, or until the end of their eligibility to the public drug plan (e.g., transfer to a long-term care facility, death). We identified statin claims from the pharmaceutical database to determine the date of statin initiation (if between 2008 and 2018) and discontinuation. We used descriptive statistics to portray the different patterns of statin use and discontinuation during the follow-up.

Results: We included 278,996 individuals, with a mean age of 84.8 years and 63% women. Around half of them were current statin users on April 1, 2013 (n=137,068; 49%). Current users were on average 84.2 years old, 57% were women, almost 70% used the medication for primary prevention, and 80% had been using a statin for >5 years. Less than half of the current users (n= 59,517; 43%) had their therapy stopped within the next five years, with a mean age at cessation of 87 years. Among the 141,928 individuals who were not using statin on April 1, 2013 (mean age 85.4 years), 18,383 (13%) had used a statin in the previous five years, and around 10% (n=14,445) initiated a statin within the next five years.

Conclusions: Long-term use of statins is frequent among oldest old individuals, especially in primary prevention. Results suggest that deprescribing could be better valued in clinical practice.