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.

Aging Research Center Karolinska Institutet Stockholm Sweden

Department of Geriatric Care OrthoGeriatrics and Rehabilitation Frailty Area E O Galliera Hospital National Relevance and High Specialization Hospital Genoa Italy

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

Division of Geriatric Cardiology and Medicine University of Florence Florence Italy

Erasmus Medical Center Rotterdam The Netherlands

Erasmus Medical Center Rotterdam The Netherlands; University of Messina Messina Italy

Geriatric Clinic Department of Medicine University of Helsinki Helsinki Finland; Institute of Health Sciences Geriatrics University of Oulu and Oulu University Hospital Oulu Finland

Geriatrics Unit Azienda ULSS 16 Padova S Antonio Hospital Padua Italy

Health Directorate Azienda ULSS 16 Padua Italy

Hospital Universitario Ramòn y Cajal Madrid Spain

National Institute on Aging Baltimore Maryland

National Research Council Neuroscience Section Padua Italy

Neurodegenerative Disease Unit Department of Basic Medicine Neuroscience and Sense Organs University of Bari Aldo Moro Bari Italy

Unit for Aging Clinical Research Department of Medicine 2 University of Cologne Cologne Germany

Unit of Biostatistics IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy

University Charles 1 Prague Czech Republic

University Hospital of Poitiers Poitiers France

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