October 26 2017

Statin initiation guidelines are not being followed, a new study has suggested. Analysis of data of patients initiated on statins found the majority had not had a score recorded for the QRISK2 prediction algorithm for cardiovascular disease. 

In addition, “most patients at high risk of CVD were not initiated on statins,” said the researchers. “One in six statin initiations were to low-risk patients indicating significant overtreatment. Initiations of statins in intermediate-risk patients rose after NICE guidelines were updated in 2014.”

The researchers from the University of Birmingham processed data relating to 1.4 million patients from 248 general practices taken from 2001-15. They found that 151,788 patients had a recorded CVD risk score since 2012 (10.67%) and that 217,860 were initiated on a statin (15.31%).

“Among patients initiated on a statin after 2012, 27.1% had a documented QRISK2 score: 2.7% of low-risk, 13.8% of intermediate-risk, and 35.0% of high-risk patients were initiated on statins.” After the 2014 NICE guideline updates, “statin initiation rates declined in high-risk patients but increased in intermediate-risk patients.”

The researchers conclude: “As CVD risk estimation is instrumental in the decision to initiate statins, all patients should have a documented CVD risk score before statin initiation. It is possible that a higher proportion of statin initiations are based on patients’ individual risk than the data in this study indicate, but the medical record should routinely reflect the incorporation of risk score in this decision.”

Professor Helen Stokes-Lampard, RCGP Chair, commented: “Patients should be reassured that GPs are highly-trained to prescribe statins and base their decisions on the circumstances of the individual patient sitting in front of them, including physical, physiological and social factors that might be affecting their health.

“This study is interesting because it looks at possible overtreatment and undertreatment, but it simplifies the true situation because it does not include any information about individual patient preferences, other health conditions, or data that was not accurately coded in patient records.”

Prof Stokes-Lampard said the study emphasises the need to calculate an accurate risk score which can help healthcare professionals to have an informed discussion with patients about the benefits and risks which are unique to them.

“As with any drug, taking statin medication has potential side-effects, and taking any medication long-term is a substantial undertaking for patients who need to be monitored by healthcare professionals. Many don't want to take statins once they have learned all the facts – and GPs will respect patient choice.”

Links:
S Finnikin et al. ‘Statin initiations and QRISK2 scoring in UK general practice: a THIN database study’. Br J Gen Pract 23 October 2017; bjgp17X693485                  
RCGP comment              

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