4CPS-221 Evaluation of the relevance of statins prescription in the elderly: towards a deprescription?

Background and Importance Statins effectiveness in reducing cardiovascular risk has been demonstrated in numerous studies. However, the assessment of the benefit/risk balance can favour deprescription Aim and Objectives Evaluation of the relevance of deprescribing statins in patients over 75 years old. Material and Methods This is a prospective observational study lasting 6 weeks in patients over 75 years of age hospitalised in the departments of cardiology, pulmonology and geriatrics. A daily analysis of computerised prescriptions on HopitalManager® software was done. It led to pharmaceutical interventions (PI), oral and written, about dosage reduction or statin discontinuation in cases of misuse or irrelevant prescription. Misuse situations correspond to statins use without indication found or with presence of adverse effects, drug interactions (DI) or contraindication (CI). Statin discontinuation was either gradual or immediate. PI monitoring was controlled at patient discharge. Results In total, 48 patients were included. Average age was 83 years and sex ratio M/F was 0.92. A statin indication was found and justified for 33 patients (68.7%). PIs were formulated for 15 patients (31.3%). Among these 15 patients, nine (18.8%) did not have an indication for a statin prescription. The proposed PI was a gradual dose reduction (accepted for 7/15 patients). Of 15 patients, six (12.5%) had no statin indication and an increase in Creatine Phospho Kinase (CPK) levels attributable to the statin. Thereby, 5/6 had an increase lower than five times normal ( 5N. It led to immediately stop the statin. PI were accepted for all six. No CI or DI were detected. The total acceptance rate for PIs is 13/15 i.e 86.7%. Conclusion and Relevance This work confirmed the multidisciplinary interest in the re-evaluation of statin indication and its deprescription when it no longer had its place in patients therapeutic strategy. However, this decision making is more complicated among hospital professionals who are not at the origin of the initiation. Strengthening the city-hospital link could improve it. In existence of protocols is also an obstacle to deprescription. Harmonising practices with the development of a deprescribing algorithm would be an ideal tool to facilitate patient care. This algorithm is the subject of a parallel work. References and/or Acknowledgements Conflict of Interest No conflict of interest.