Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
BMJ Open. 2024 Oct 8;14(10):e085569. doi: 10.1136/bmjopen-2024-085569.
In the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.
Qualitative descriptive approach including four focus groups. Inductive and deductive thematic analysis.
18 physicians including two neurologists, three cardiologists, seven hospital internists and six primary care providers (PCPs) recruited at a hospital and primary care practices in the area of Bern in Switzerland.
Concerning knowledge about statins in older adults, physicians reported defining if a patient is treated for primary or secondary prevention as challenging and that lack of evidence makes the decision to continue or discontinue the statin difficult. In terms of beliefs, fear of a possible rebound effect after statin discontinuation was reported. Regarding decision-making, physicians mentioned that statin discontinuation or continuation should be a shared decision between the patient and the physician. Concerning the professional role, environmental context and resources, the PCP office was identified as the ideal setting to discuss discontinuation, as all necessary information is available and PCPs have a longer relationship with the patients, thus facilitating a shared decision. Discontinuation of a chronic medication was perceived as difficult in general. Furthermore, PCPs noticed a possible negative impact on patient-physician relationship as some patients felt not being worth it, given up or undertreated if the statin was discontinued.
This study highlights the challenges of statin continuation and discontinuation in older patients and the crucial role of PCPs in situations with unclear evidence for a medication, where shared decision-making between physicians and patients is important. More evidence forming the background for a decision aid would be helpful.
在他汀类药物用于老年人一级心血管预防的证据有限的情况下，我们评估了医生在该人群中决定继续或停止使用他汀类药物的观点。
包括四个焦点小组的定性描述方法。归纳和演绎主题分析。
在瑞士伯尔尼地区的一家医院和初级保健诊所招募了 18 名医生，包括两名神经科医生、三名心脏病专家、七名医院内科医生和六名初级保健提供者（PCP）。
关于老年患者使用他汀类药物的知识，医生报告称，确定患者是接受一级预防还是二级预防治疗具有挑战性，并且缺乏证据使得继续或停止使用他汀类药物的决定变得困难。在信念方面，报告称担心他汀类药物停药后可能出现反弹效应。关于决策，医生提到他汀类药物的停药或继续应该是患者和医生之间的共同决策。在专业角色、环境背景和资源方面，PCP 办公室被确定为讨论停药的理想场所，因为所有必要的信息都可用，而且 PCP 与患者的关系更长，因此有利于共同决策。一般来说，停止使用慢性药物被认为是困难的。此外，PCP 注意到如果停止使用他汀类药物，可能会对医患关系产生负面影响，因为一些患者感到不值得、放弃或治疗不足。
本研究强调了在老年患者中继续和停止使用他汀类药物的挑战，以及 PCP 在证据不明确的情况下在药物治疗中的关键作用，在这种情况下，医生和患者之间的共同决策非常重要。更多有助于制定决策辅助工具的证据将是有帮助的。
