BACKGROUND: Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners' (GPs) advice to stop statins in oldest-old patients. OBJECTIVE: To investigate the influence of a history of CVD, statin-related side effects, frailty and short life expectancy, on GPs' advice to stop statins in oldest-old patients. DESIGN: We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. MAIN MEASURES: Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (ORadj) were calculated for GPs' advice to stop. KEY RESULTS: Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45-47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89-90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (ORadj 13.8, 95%CI 12.6-15.1), with side effects compared to without ORadj 1.62 (95%CI 1.5-1.7) and with frailty (ORadj 4.1, 95%CI 3.8-4.4) compared to without. Shortened life expectancy increased advice to stop (ORadj 50.7, 95%CI 45.5-56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19-42) to 98% (95% CI 96-99). CONCLUSIONS: The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs' advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs' advice to stop statins.

AP HP Assistance Publique des Hôpitaux de Paris Université Paris 13 Paris France

Center for Primary Health Care Research Clinical Research Center Lund University Malmö Sweden

Centre for Primary Health Care University of Basel Basel Switzerland

Department for Family Medicine Health Center Tuzla Medical School University of Tuzla Tuzla Bosnia and Herzegovina

Department of Clinical Sciences Section of Family Medicine Lund University Malmö Sweden

Department of Community Care and Ambulatory Medicine Institute of Family Medicine Lausanne Lausanne Switzerland

Department of Family Medicine Amsterdam UMC location AMC University of Amsterdam Amsterdam The Netherlands

Department of Family Medicine Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education Kiev Ukraine

Department of Family Medicine Medical Faculty University of Ljubljana Ljubljana Slovenia

Department of Family Medicine NOVA Medical School Lisbon Portugal

Department of Family Medicine Semmelweis University Budapest Hungary

Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of General Practice and Family Medicine Center for Public Health Medical University of Vienna Vienna Austria

Department of General Practice and Primary Health Care School of Population Health Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand

Department of General Practice Erasmus Medical Center Rotterdam The Netherlands

Department of General Practice University of Tampere Tampere Finland

Department of Nephrology and Department of Family Medicine University Clinical Centre University St Cyril and Metodius Skopje Macedonia

Department of Primary and Community Care Radboud University Medical Center Nijmegen The Netherlands

Department of Public Health and Primary Care Leiden University Medical Center Hippocratespad 21 2333 ZD Leiden The Netherlands

Department of Public Health and Primary Care Universiteit Leuven Leuven Belgium

Department of Research and Development Region Kronoberg Sweden

Erzincan University Family Medicine Department Erzincan Turkey

Faculty of Medicine Department of Family Medicine Riga Stradiņs University Riga Latvia

Family Medicine Department Wroclaw Medical University Wrocław Poland

Goethe University Institute of General Practice Frankfurt Main Germany

Hospital Israelita Albert Einstein São Paulo Brazil

Institute for Health and Behaviour Research Unit INSIDE University of Luxembourg Luxembourg City Luxembourg

Institute of Primary and Community Care Lucerne Lucerne Switzerland

Institute of Primary Care University Hospital Zurich University of Zurich Zurich Switzerland

Institute of Primary Health Care University of Bern Bern Switzerland

Irish College of General Practitioners Dublin Ireland

Ordinace Řepy s r o Prague Prague Czech Republic

Primary Care and Health Sciences Keele University Keele Staffordshire ST5 5BG UK

Primary Care Region Kronoberg Växjö Sweden

Primary Care Unit Faculty of Medicine University of Geneva Geneva Switzerland

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

SNAMID Caserta Italy

SSLMG Societé Scientifique Luxembourgois en Medicine generale Luxembourg City Luxembourg

Timis Society of Family Medicine Sano Med West Private Clinic Timisoara Romania

Vennesla Primary Health Care Centre Bergen Norway

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