Evidence map›Paper›PMID 30642823›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2019

One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins.

Michael A Campitelli, Colleen J Maxwell, Laura C Maclagan, Dennis T Ko, Chaim M Bell, Lianne Jeffs, Andrew M Morris, Kate L Lapane, Nick Daneman, Susan E Bronskill

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Review
  6. Article
  7. All, some or none? Statin prescribing for frail older adults.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Michael A CampitelliICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Colleen J MaxwellICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Laura C MaclaganICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Dennis T KoICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Chaim M BellICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Lianne JeffsICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Andrew M MorrisICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Kate L LapaneICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Nick DanemanICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
Susan E BronskillICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass. susan.bronskill@ices.on.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting.

methodsWe conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively.

resultsUsing propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins.

interpretationThe rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.

Indexed as

AgedAged, 80 and overAge FactorsCardiovascular DiseasesDose-Response Relationship, DrugFemaleHomes for the AgedHospitalizationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsLong-Term CareMaleNursing HomesOntarioPatient AdmissionPropensity ScoreHydroxymethylglutaryl-CoA Reductase Inhibitors

Identifiers

PMID30642823
PMCPMC6333549

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.