We need to rethink prevention. We take a drug tested for 2 or three years and tell populations that they should take these drugs for 20 or 40 or more years without adequate evidence of long term effectiveness or safety. Even our 80 year olds may outlive the duration of the studies supporting drugs we are encouraged to use. Guidelines purporting to be evidence based need to specify not only the grade evidence, but the details with links to the actual studies. We need to know who was studied, for how long, with what dropout rate, whether there was a washout period at the start, what were the ADR's, what was the absolute risk reduction and number needed to treat. We need to know statistical significance, then our patients can decide whether the benefit is clinically significant for them. We also need to know the cost right up front. We supposedly have abandoned paternalism in medicine. We espouse informed decision making on the patient's part. Instead we have paternalism of the medical establishment toward the physicians who end up making decisions regarding their patients without themselves being adequately informed let alone being able to advise their patients with enough information to make their own decisions. But I digress to another very important topic, availability of research findings and quality of medical clinical research.
U.K. Geriatrician: Statins, Antihypertensives "Greatly" Overprescribed for Adults 80 and Older — Physician’s First Watch
U.K. Geriatrician: Statins, Antihypertensives "Greatly" Overprescribed for Adults 80 and Older
By Amy Orciari Herman
"The data strongly suggest that we are over-treating many healthy patients aged 80+ regarding stroke prevention," concludes U.K. geriatrician Kit Byatt in a perspective published in Evidence-Based Medicine.
Byatt offers a brief review of the evidence, noting that the large HYVET study in China and Europe showed only modest stroke-prevention benefits with antihypertensive therapy in those aged 80 and older. Similarly, the PROSPER trial, a large study of pravastatin in patients aged 70 to 82 in Europe, failed to find a significant stroke-prevention benefit with treatment. Byatt also notes that morbidity associated with statins may be underestimated
He writes: "We need actively to rethink our priorities and beliefs about stroke prevention, actively informing and involving the views of the key person, the patient. Most of the patients will probably eschew the modest potential benefit, preferring the reduced burden of polypharmacy and side effects judged as 'minor' by the prescriber."
Reader Comments (5)
Of course, it is easier to prescribe drugs than to make seniors' life better. It is much, much more benefite if we make people over 80 life more interesting and give them some positive goal. We see it every day examinig octogenerians (and even younger patients!).
But it is harder to move the nation in that direction.
The british have often been more conservative than US re: treatment of hypertension in the elderly. Looks as though they might have been correct.
Thank God some sanity in that area. I see all the complications and the Cardiologists dismiss the issue.
we have more than 1500 guidelines, often not consented, mostly not prooved in the old patient: I consent to Dr Byatt and hope, a majority of drs all over the world will perform new thinking and "guideline constructing" . Not: what is possible to perform to resolve a specific problem, but: what can we do to achive a tolerable quality of live!