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Inadequate prescribing for patients on statin therapy

Inadequate prescribing for patients on statin therapy

Publication date: Wednesday, 06 December 2017
Contributor(s): Jeremy Bray

A study suggests that high-risk patients are being under-prescribed statins whereas patients in low-risk categories are being overtreated. Researchers have shown that statins are usually prescribed without recording of the QRISK2 cardiovascular risk assessment score recommended by NICE. Even when a score is documented, the majority of high-risk patients do not receive statins

Finnikin et al. analysed GP prescribing data for 1.4 million adults from 248 practices across the UK between January 2000 and December 2015, to examine the relationship between cardiovascular risk scoring and the initiation of statins in primary care.

Although there was a steady increase in the recording of QRISK2 score since 2012, when the tool became available, 73% of patients initiated on statins did not have a score recorded. Of those who did, only 35% of patients in the high-risk category were put on a statin. Conversely, one in six statin initiations were in patients in the low-risk category, indicating significant overtreatment in this group.

The researchers also investigated the effect on statin prescribing of the 2014 NICE guidance on lipid modification, which halved the recommended threshold for statin initiation to include patients with a 10% risk of developing cardiovascular disease over 10 years. They found that the rate of statin initiation increased in patients at intermediate risk while it rate decreased among high-risk patients, between the 18 months before and after publication of the guidance.

Professor Helen Stokes-Lampard, chair of the Royal College of General Practice, said the study “simplifies the true situation” as it did not consider individual patient circumstances that influence statin prescribing, such as patient preference and comorbidities. However, she said the study “emphasises the importance of calculating an accurate risk score which can then help healthcare professionals have an honest discussion with their patients about the benefits and risks which are unique to them.”

ACTION

This study emphasises the importance of calculating an accurate risk score which can then help healthcare professionals have an honest discussion with their patients about the benefits and risks of taking statins.

Finnikin S et al. Statin initiations and QRISK2 scoring in UK general practice: a THIN database study. Brit J Gen Pract 2017;23: bjgp17X693485
Topics covered:
Category: Evidence in Practice
Edition: Volume 2 Number 11 PCCJ Online 2017
Contributor(s): Jeremy Bray

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