Hospice prescribers and pharmacists have long approached statins as appropriate for discontinuation in their patients who have no active cardiovascular disease since preventative or prophylaxis medications, as well as medications with long-term therapeutic outcomes, are not considered part of palliative care. With the benefits of statin discontinuation ranging from decreasing pill burden to preventing myopathy, from cost-savings to fewer drug-drug interactions, it has become a common practice. However, many hospice prescribers still overlook the potential benefits of statin discontinuation such that they do not always consider it in a timely manner after admission to hospice.
When the hospice team admits a patient with no known cardiovascular disease who is on a statin, it is helpful to remind new hospice prescribers of research demonstrating that the discontinuation of statins in this population does not alter mortality rates within 60 days of discontinuation or alter the median time to death. Similarly, discontinuation does not appear to affect rates of cardiovascular events but may actually provide improvements in quality of life. Research findings also imply that it is possible that statin deprescribing may lead to a reduction in the number of non-statin prescriptions required, perhaps due to fewer adverse effects requiring treatment for patient comfort. It is prudent to consider the risks of continuation of any medication that no longer provides benefit, especially when dysphagia is present.
Of course, discussions about discontinuing any therapy should occur in the context of shared decision making, especially in the case of statins as research indicates that neither continuation nor discontinuation is clearly superior. Furthermore, the data surrounding the topic of stopping statins in late-stage terminal patients serves as a reminder of the importance of utilizing patient-centered ongoing medication therapy reviews as an opportunity to continually assess the risk versus benefit of all components of a hospice patient’s medication regimen.
Kutner, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA. 2015 May;175(5):691-700 https://www.ncbi.nlm.nih.gov/pubmed/25798575
Holmes H. & Todd A. Evidence-based deprescribing of statins in patients with advanced illness. JAMA. 2015 May;175(5):701-702 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420700/
Voelker R. Statin use may stop when illness is terminal, study says. JAMA. 2014 Jul 16;312(3):221