Skip to main content
Erschienen in: Cardiovascular Drugs and Therapy 3/2017

14.07.2017 | ORIGINAL ARTICLE

Primary Care Physician Perspectives on Barriers to Statin Treatment

verfasst von: Rikki M. Tanner, Monika M. Safford, Keri L. Monda, Benjamin Taylor, Ronan O’Beirne, Melanie Morris, Lisandro D. Colantonio, Ricardo Dent, Paul Muntner, Robert S. Rosenson

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 3/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Discontinuation of statin therapy represents a major challenge for effective cardiovascular disease prevention. It is unclear how often primary care physicians (PCPs) re-initiate statins and what barriers they encounter. We aimed to identify PCP perspectives on factors influencing statin re-initiation.

Methods

We conducted six nominal group discussions with 23 PCPs from the Deep South Continuing Medical Education network. PCPs answered questions about statin side effects, reasons their patients reported for discontinuing statins, how they respond when discontinuation is reported, and barriers they encounter in getting their patients to re-initiate statin therapy. Each group generated a list of responses in round-robin fashion. Then, each PCP independently ranked their top three responses to each question. For each PCP, the most important reason was given a weight of 3 votes, and the second and third most important reasons were given weights of 2 and 1, respectively. We categorized the individual responses into themes and determined the relative importance of each theme using a “percent of available votes” metric.

Results

PCPs reported that side effects, especially muscle/joint-related symptoms, were the most common reason patients reported for statin discontinuation (47% of available votes). PCPs reported statin re-challenge as their most common response when a patient discontinues statin use (31% of available votes). Patients’ fear of side effects was ranked as the biggest challenge PCPs encounter in getting their patients to re-initiate statin therapy (70% of available votes).

Conclusion

PCPs face challenges getting their patients to re-initiate statins, particularly after a patient reports side effects.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Taylor F, Ward K, Moore TH, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2011;1:CD004816. Taylor F, Ward K, Moore TH, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2011;1:CD004816.
2.
Zurück zum Zitat Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–78.CrossRefPubMed Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–78.CrossRefPubMed
3.
Zurück zum Zitat Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6(3):208–15.CrossRefPubMed Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6(3):208–15.CrossRefPubMed
4.
Zurück zum Zitat Zhang H, Plutzky J, Skentzos S, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158(7):526–34.CrossRefPubMedPubMedCentral Zhang H, Plutzky J, Skentzos S, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158(7):526–34.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Mampuya WM, Frid D, Rocco M, et al. Treatment strategies in patients with statin intolerance: the Cleveland Clinic experience. Am Heart J. 2013;166(3):597–603.CrossRefPubMedPubMedCentral Mampuya WM, Frid D, Rocco M, et al. Treatment strategies in patients with statin intolerance: the Cleveland Clinic experience. Am Heart J. 2013;166(3):597–603.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Eaton CB, Galliher JM, McBride PE, Bonham AJ, Kappus JA, Hickner J. Family physician's knowledge, beliefs, and self-reported practice patterns regarding hyperlipidemia: a National Research Network (NRN) survey. JABFM. 2006;19(1):46–53.CrossRefPubMed Eaton CB, Galliher JM, McBride PE, Bonham AJ, Kappus JA, Hickner J. Family physician's knowledge, beliefs, and self-reported practice patterns regarding hyperlipidemia: a National Research Network (NRN) survey. JABFM. 2006;19(1):46–53.CrossRefPubMed
7.
Zurück zum Zitat Safford MM, Shewchuk R, Qu H, et al. Reasons for not intensifying medications: differentiating “clinical inertia” from appropriate care. J Gen Int Med. 2007;22(12):1648–55.CrossRef Safford MM, Shewchuk R, Qu H, et al. Reasons for not intensifying medications: differentiating “clinical inertia” from appropriate care. J Gen Int Med. 2007;22(12):1648–55.CrossRef
8.
Zurück zum Zitat Shewchuk R, O'Connor SJ. Using cognitive concept mapping to understand what health care means to the elderly: an illustrative approach for planning and marketing. Health Mark Q. 2002;20(2):69–88.CrossRefPubMed Shewchuk R, O'Connor SJ. Using cognitive concept mapping to understand what health care means to the elderly: an illustrative approach for planning and marketing. Health Mark Q. 2002;20(2):69–88.CrossRefPubMed
9.
Zurück zum Zitat Levine DA, Saag KG, Casebeer LL, Colon-Emeric C, Lyles KW, Shewchuk RM. Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention. J Am Med Dir Assoc. 2006;7(7):420–5.CrossRefPubMedPubMedCentral Levine DA, Saag KG, Casebeer LL, Colon-Emeric C, Lyles KW, Shewchuk RM. Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention. J Am Med Dir Assoc. 2006;7(7):420–5.CrossRefPubMedPubMedCentral
10.
11.
Zurück zum Zitat Hickling JA, Nazareth I, Rogers S. The barriers to effective management of heart failure in general practice. Brit J Gen Pract. 2001;51(469):615–8. Hickling JA, Nazareth I, Rogers S. The barriers to effective management of heart failure in general practice. Brit J Gen Pract. 2001;51(469):615–8.
12.
Zurück zum Zitat Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7(4) Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci. 1971;7(4)
13.
Zurück zum Zitat Van Breda A. Steps to analysing multiple-group NGT data. Soc Work Pract Res. 2005;17(1):1–14. Van Breda A. Steps to analysing multiple-group NGT data. Soc Work Pract Res. 2005;17(1):1–14.
14.
Zurück zum Zitat Byington RP, Furberg CD, Crouse JR 3rd, Espeland MA, Bond MG. Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II). Am J Cardiol. 1995;76(9):54C–9C.CrossRefPubMed Byington RP, Furberg CD, Crouse JR 3rd, Espeland MA, Bond MG. Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II). Am J Cardiol. 1995;76(9):54C–9C.CrossRefPubMed
15.
Zurück zum Zitat Ohsfeldt RL, Gandhi SK, Smolen LJ, et al. Cost effectiveness of rosuvastatin in patients at risk of cardiovascular disease based on findings from the JUPITER trial. J Med Econ. 2010;13(3):428–37.CrossRefPubMed Ohsfeldt RL, Gandhi SK, Smolen LJ, et al. Cost effectiveness of rosuvastatin in patients at risk of cardiovascular disease based on findings from the JUPITER trial. J Med Econ. 2010;13(3):428–37.CrossRefPubMed
16.
Zurück zum Zitat Ramsey SD, Clarke LD, Roberts CS, Sullivan SD, Johnson SJ, Liu LZ. An economic evaluation of atorvastatin for primary prevention of cardiovascular events in type 2 diabetes. Pharmaco Economics. 2008;26(4):329–39.CrossRef Ramsey SD, Clarke LD, Roberts CS, Sullivan SD, Johnson SJ, Liu LZ. An economic evaluation of atorvastatin for primary prevention of cardiovascular events in type 2 diabetes. Pharmaco Economics. 2008;26(4):329–39.CrossRef
17.
Zurück zum Zitat Wei MY, Ito MK, Cohen JD, Brinton EA, Jacobson TA. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education. J Clin Lipidol. 2013;7(5):472–83.CrossRefPubMed Wei MY, Ito MK, Cohen JD, Brinton EA, Jacobson TA. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education. J Clin Lipidol. 2013;7(5):472–83.CrossRefPubMed
18.
Zurück zum Zitat Thompson PD, Panza G, Zaleski A, Taylor B. Statin-associated side effects. J Am Coll Cardiol. 2016;67(20):2395–410.CrossRefPubMed Thompson PD, Panza G, Zaleski A, Taylor B. Statin-associated side effects. J Am Coll Cardiol. 2016;67(20):2395–410.CrossRefPubMed
19.
Zurück zum Zitat Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA. The National Lipid Association’s Muscle Safety Expert Panel: an assessment by the statin muscle safety task force: 2014 update. J Clin Lipidol. 2014;8(3 Suppl):S58–71.CrossRefPubMed Rosenson RS, Baker SK, Jacobson TA, Kopecky SL, Parker BA. The National Lipid Association’s Muscle Safety Expert Panel: an assessment by the statin muscle safety task force: 2014 update. J Clin Lipidol. 2014;8(3 Suppl):S58–71.CrossRefPubMed
20.
Zurück zum Zitat Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Am Heart J. 2014;168(1):6–15.CrossRefPubMed Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Am Heart J. 2014;168(1):6–15.CrossRefPubMed
21.
Zurück zum Zitat Nissen SE, Stroes E, Dent-Acosta RE, et al. Efficacy and tolerability of evolocumab vs ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial. JAMA. 2016;315(15):1580–90.CrossRefPubMed Nissen SE, Stroes E, Dent-Acosta RE, et al. Efficacy and tolerability of evolocumab vs ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial. JAMA. 2016;315(15):1580–90.CrossRefPubMed
22.
Zurück zum Zitat Evans WJ, Cannon JG. The metabolic effects of exercise-induced muscle damage. Exerc Sport Sci Rev. 1991;19:99–125.CrossRefPubMed Evans WJ, Cannon JG. The metabolic effects of exercise-induced muscle damage. Exerc Sport Sci Rev. 1991;19:99–125.CrossRefPubMed
23.
Zurück zum Zitat Rojas-Fernandez C, Hudani Z, Bittner V. Statins and cognitive side effects: what cardiologists need to know. Endocrinol Metab Clin N Am. 2016;45(1):101–16.CrossRef Rojas-Fernandez C, Hudani Z, Bittner V. Statins and cognitive side effects: what cardiologists need to know. Endocrinol Metab Clin N Am. 2016;45(1):101–16.CrossRef
24.
Zurück zum Zitat Samaras K, Brodaty H, Sachdev PS. Does statin use cause memory decline in the elderly? Trends Cardiovasc Med. 2016;26(6):550–65.CrossRefPubMed Samaras K, Brodaty H, Sachdev PS. Does statin use cause memory decline in the elderly? Trends Cardiovasc Med. 2016;26(6):550–65.CrossRefPubMed
25.
Zurück zum Zitat de Denus S, Spinler SA, Miller K, Peterson AM. Statins and liver toxicity: a meta-analysis. Pharmacotherapy. 2004;24(5):584–91.CrossRefPubMed de Denus S, Spinler SA, Miller K, Peterson AM. Statins and liver toxicity: a meta-analysis. Pharmacotherapy. 2004;24(5):584–91.CrossRefPubMed
26.
Zurück zum Zitat Calderon RM, Cubeddu LX, Goldberg RB, Schiff ER. Statins in the treatment of dyslipidemia in the presence of elevated liver aminotransferase levels: a therapeutic dilemma. Mayo Clin Proc. 2010;85(4):349–56.CrossRefPubMedPubMedCentral Calderon RM, Cubeddu LX, Goldberg RB, Schiff ER. Statins in the treatment of dyslipidemia in the presence of elevated liver aminotransferase levels: a therapeutic dilemma. Mayo Clin Proc. 2010;85(4):349–56.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Boehme AK, Davies SL, Moneyham L, Shrestha S, Schumacher J, Kempf MC. A qualitative study on factors impacting HIV care adherence among postpartum HIV-infected women in the rural southeastern USA. AIDS Care. 2014;26(5):574–81.CrossRefPubMed Boehme AK, Davies SL, Moneyham L, Shrestha S, Schumacher J, Kempf MC. A qualitative study on factors impacting HIV care adherence among postpartum HIV-infected women in the rural southeastern USA. AIDS Care. 2014;26(5):574–81.CrossRefPubMed
28.
Zurück zum Zitat Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Fam Pract. 2017;18(1):41.CrossRefPubMedPubMedCentral Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Fam Pract. 2017;18(1):41.CrossRefPubMedPubMedCentral
Metadaten
Titel
Primary Care Physician Perspectives on Barriers to Statin Treatment
verfasst von
Rikki M. Tanner
Monika M. Safford
Keri L. Monda
Benjamin Taylor
Ronan O’Beirne
Melanie Morris
Lisandro D. Colantonio
Ricardo Dent
Paul Muntner
Robert S. Rosenson
Publikationsdatum
14.07.2017
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 3/2017
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-017-6738-x

Weitere Artikel der Ausgabe 3/2017

Cardiovascular Drugs and Therapy 3/2017 Zur Ausgabe

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

10.05.2024 Hypercholesterinämie Nachrichten

Patienten mit Arteriosklerose-bedingten kardiovaskulären Erkrankungen, die trotz Statineinnahme zu hohe Triglyzeridspiegel haben, profitieren von einer Behandlung mit Icosapent-Ethyl, und zwar unabhängig vom individuellen Risikoprofil.

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

In den USA ist erstmals eine bioresorbierbare Gefäßstütze – auch Scaffold genannt – zur Rekanalisation infrapoplitealer Arterien bei schwerer PAVK zugelassen worden. Das markiert einen Wendepunkt in der Geschichte dieser speziellen Gefäßstützen.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.