Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

Alberto Pilotto, Pietro Gallina, Francesco Panza, Massimiliano Copetti, Alberto Cella, Alfonso Cruz-Jentoft, Julia Daragjati, Luigi Ferrucci, Stefania Maggi, Francesco Mattace-Raso, Marc Paccalin, Maria Cristina Polidori, Eva Topinkova, Gianluca Trifirò, Anna Karin Welmer, Timo Strandberg, Niccolò Marchionni

Research output: Contribution to journalArticle

Abstract

Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - May 6 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Pilotto, A., Gallina, P., Panza, F., Copetti, M., Cella, A., Cruz-Jentoft, A., Daragjati, J., Ferrucci, L., Maggi, S., Mattace-Raso, F., Paccalin, M., Polidori, M. C., Topinkova, E., Trifirò, G., Welmer, A. K., Strandberg, T., & Marchionni, N. (Accepted/In press). Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease. American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2016.08.042