Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease.
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.
Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy; Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy.
Alberto
A
Pilotto
Health Directorate, Azienda ULSS 16, Padua, Italy.
Pietro
P
Gallina
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy. Electronic address: geriat.dot@geriatria.uniba.it.
Francesco
F
Panza
Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
Massimiliano
M
Copetti
Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.
Alberto
A
Cella
Hospital Universitario Ramòn y Cajal, Madrid, Spain.
Alfonso
A
Cruz-Jentoft
Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padua, Italy.
Julia
J
Daragjati
National Institute on Aging, Baltimore, Maryland.
Luigi
L
Ferrucci
National Research Council, Neuroscience Section, Padua, Italy.
Stefania
S
Maggi
Erasmus Medical Center, Rotterdam, The Netherlands.
Francesco
F
Mattace-Raso
University Hospital of Poitiers, Poitiers, France.
Marc
M
Paccalin
Unit for Aging Clinical Research, Department of Medicine II, University of Cologne, Cologne, Germany.
Maria Cristina
MC
Polidori
University Charles I, Prague, Czech Republic.
Eva
E
Topinkova
Erasmus Medical Center, Rotterdam, The Netherlands; University of Messina, Messina, Italy.
Gianluca
G
Trifirò
Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
Anna-Karin
AK
Welmer
Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland; Institute of Health Sciences/Geriatrics, University of Oulu, and Oulu University Hospital, Oulu, Finland.
Timo
T
Strandberg
Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy.
Niccolò
N
Marchionni
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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