title: Statins in heart failure: retrospective cohort study using routine primary care data.
abstract: BACKGROUND
  Studies suggest no benefit from statins in heart failure (HF), but many individuals in primary care are prescribed statins before HF diagnosis. This study aimed to assess the effect of a statin prescription prior to HF diagnosis on survival in an incident HF population.
  
  
  METHODS
  Cases of HF diagnosed between 1995 and 2004 in 315 UK primary care practices were identified from electronic case records and followed up for 2 years from diagnosis. Statin prescribing before and after HF diagnosis was assessed, and Cox regression was used to determine the contribution of statin treatment to survival.
  
  
  RESULTS
  A total of 10,914 cases met the inclusion criteria of whom 20% (2185/10,914) were treated with a statin prior to HF diagnosis. Two per cent (191/8729) had an initial statin prescription following diagnosis. Cases prescribed a statin before heart failure diagnosis had a lower risk of death in the subsequent 2 years (hazard ratio 0.52; 95% confidence interval 0.39-0.68), after adjustment for confounders.
  
  
  CONCLUSIONS
  Most people with heart failure prescribed statins in primary care commenced them prior to diagnosis and appeared to gain benefit, presumably through the effect of statins on cardiovascular co-morbidities. Primary care physicians should not discontinue prior statin treatment at the time of heart failure diagnosis.
authors.affiliation: Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Ronan P
authors.initials: RP
authors.lastname: Ryan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.forename: John A A
authors.initials: JA
authors.lastname: Macleod
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors