title: Statins in the last six months of life: a recognizable, life-limiting condition does not decrease their use.
abstract: BACKGROUND
  Some have advocated discontinuing statins in patients with life-limiting conditions. However, the extent of statin use at the end of life has yet to be described and whether statin prescribing may already be influenced by the presence of a recognizable, life-limiting condition is unknown.
  
  
  OBJECTIVE
  To measure the prevalence of statin use during the last 6 months of life and determine if statin prescribing varies according to the presence of a recognizable, life-limiting condition.
  
  
  METHODS
  Matched, case-control trial nested within a retrospective, cohort study.
  
  
  METHODS
  From 3031 VISN 11 patients who died in FY2004, we identified 1584 (52%) receiving statins at least 6 months before death. Of those, we identified 337 cases with a recognizable, life-limiting condition and 1247 controls matched on number of comorbidities, age, and socioeconomic status.
  
  
  METHODS
  We used survival analysis to test the relationship between days without statins and the presence of a life limiting condition, while controlling for pills supplied and comorbidity score.
  
  
  RESULTS
  There was no significant difference in the time off statins between cases and controls even though the study was sufficiently powered to detect one.
  
  
  CONCLUSIONS
  These findings underscore a missed opportunity to reduce the therapeutic burden upon dying patients and limit health care spending.
authors.affiliation: Veterans Health Administration, Health Services Research and Development Center of Excellence, Ann Arbor, Michigan, USA. mariajs@umich.edu
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Silveira
authors.forename: Anamaria Segnini
authors.initials: AS
authors.lastname: Kazanis
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Shevrin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D007087:Illinois; D007196:Indiana; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D019452:Terminally Ill; D028761:Withholding Treatment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors