Are hospice patients prescribed statins (HMG-CoA reductase inhibitors) for hyperlipidemia?

From the Guidelines

Hospice patients are generally not prescribed statins for hyperlipidemia, as the focus of care shifts from curative treatments to comfort and quality of life, and statins provide little benefit in the limited life expectancy context of hospice care. When a patient enters hospice care, the primary concern is no longer the reduction of long-term cardiovascular risk, but rather the management of symptoms that directly impact the patient's comfort and dignity. Medications like statins, which are preventative in nature, may be discontinued because they can potentially cause side effects like muscle pain, liver problems, or drug interactions that could reduce quality of life 1.

The decision to continue or discontinue cholesterol medications should be individualized based on the patient's specific situation, symptoms, and goals of care. Healthcare providers typically review all medications when a patient enters hospice and discontinue those that no longer align with the comfort-focused approach, redirecting efforts toward managing symptoms like pain, anxiety, nausea, or respiratory distress that directly impact the patient's comfort and dignity. According to the most recent guidelines, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate in older adults with diabetes who require palliative care 1.

Some key points to consider when making this decision include:

• The patient's limited life expectancy and the focus on comfort and quality of life
• The potential side effects of statins and their impact on the patient's quality of life
• The individualized approach to care, taking into account the patient's specific situation, symptoms, and goals of care
• The redirection of efforts toward managing symptoms that directly impact the patient's comfort and dignity.

Overall, the goal of care in hospice patients is to prioritize comfort, symptom control, and preservation of dignity and quality of life, rather than focusing on curative treatments or preventative measures like statin therapy 1.

From the Research

Statin Prescription for Hospice Patients

• There is no direct evidence in the provided studies that specifically addresses the prescription of statins for hospice patients with hyperlipidemia.
• However, a study from 2 discusses the use of cholesterol-lowering drugs in the elderly, suggesting that they should be started or continued in elderly patients with vascular disease, but stopped in case of unpleasant side effects or if life expectancy is no more than 1 to 2 years.
• Another study from 3 reviews the pharmacological properties and use of atorvastatin in dyslipidaemia, but does not mention hospice patients specifically.
• Studies from 4 and 5 focus on the management of dyslipidemia and the use of omega-3 fatty acids as an adjunct to statin therapy, but do not provide information on statin prescription for hospice patients.
• A study from 6 discusses the use of omega-3 carboxylic acids in statin-treated patients with high levels of triglycerides and low levels of high-density lipoprotein cholesterol, but does not address the specific population of hospice patients.

Use of Statins in Elderly Patients

• The study from 2 suggests that cholesterol-lowering drugs, including statins, should be used judiciously in elderly patients, taking into account their life expectancy, frailty, and competing risks.
• The decision to prescribe statins to elderly patients should be based on an individualized risk assessment, considering factors such as vascular disease, diabetes, and high blood pressure.
• There is no clear guidance on the use of statins in hospice patients, who may have a limited life expectancy and may not benefit from long-term lipid-lowering therapy.

Hyperlipidemia Management

• The studies from 3, 4, and 5 discuss the management of dyslipidemia using statins and other lipid-lowering therapies, but do not provide specific guidance on the management of hyperlipidemia in hospice patients.
• The study from 6 investigates the use of omega-3 carboxylic acids as an adjunct to statin therapy in patients with high triglycerides and low HDL-C, but does not address the specific needs of hospice patients.