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Primary Care Physician Perspectives on Barriers to Statin Treatment

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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.

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Acknowledgements

The design and conduct of the study, analysis and interpretation of the data, and preparation of the manuscript were supported through a research grant from Amgen, Inc. (Thousand Oaks, CA). The academic authors conducted all analyses and maintained the rights to publish this article.

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Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294, USA

    Rikki M. Tanner, Lisandro D. Colantonio & Paul Muntner

  2. General Internal Medicine, Weill Cornell Medicine, 1300 York Ave, New York, NY, 10065, USA

    Monika M. Safford

  3. The Center for Observational Research, Amgen, Inc, One Amgen Center Dr, Thousand Oaks, CA, 91320, USA

    Keri L. Monda & Benjamin Taylor

  4. Division of Continuing Medical Education, University of Alabama at Birmingham, 1670 University Blvd, Suite L211, Birmingham, AL, 35294, USA

    Ronan O’Beirne & Melanie Morris

  5. Esperion Therapeutics, 3891 Ranchero Dr, Ann Arbor, MI, 48108, USA

    Ricardo Dent

  6. Division of Cardiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA

    Robert S. Rosenson

Authors
  1. Rikki M. Tanner
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  2. Monika M. Safford
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  3. Keri L. Monda
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  4. Benjamin Taylor
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  5. Ronan O’Beirne
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  6. Melanie Morris
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  7. Lisandro D. Colantonio
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  8. Ricardo Dent
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  9. Paul Muntner
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  10. Robert S. Rosenson
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Corresponding author

Correspondence to Rikki M. Tanner.

Ethics declarations

This study was funded by a research grant from Amgen, Inc. (Thousand Oaks, CA). RMT, RO, MM, and LDC declare that they have no conflicts of interest. MMS has received research support from and served on an advisory board for Amgen, Inc. KLM and BT are employees and stockholders of Amgen, Inc. RD is an employee of Esperion Therapeutics and was an employee and stockholder of Amgen, Inc. at the time of this study. PM has received research support and honoraria from Amgen, Inc. RSR has received research grants from Akcea, Amgen, Astra Zeneca, Esperion, and Medicines Company; honoraria from Kowa; royalties from UpToDate, Inc.; and has served as a consultant or on advisory boards for Akcea, Amgen, Eli Lilly, Regeneron, and Sanofi Aventis. This study was conducted in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments, and was approved by the Institutional Review Board at the University of Alabama at Birmingham, which waived the need for written informed consent.

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Tanner, R.M., Safford, M.M., Monda, K.L. et al. Primary Care Physician Perspectives on Barriers to Statin Treatment. Cardiovasc Drugs Ther 31, 303–309 (2017). https://doi.org/10.1007/s10557-017-6738-x

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  • DOI: https://doi.org/10.1007/s10557-017-6738-x

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