GPs fear workload surge as NICE backs statins for 'almost all' over-60s

GPs fear huge workload rises after researchers found NICE's updated statin risk threshold qualifies almost all men over 60 and women over 65 to receive the drug as a preventative measure against CVD.

NICE updated its guidelines on prescribing statins in 2011, ushering in new rules that recommended prescribing the drugs to patients with a 10-year risk of cardiovascular event of 10%, down from the previous score of 20%.

The current study, published in the British Journal of General Practice (BJGP), analysed for the first time the consequences this change would have on the English population, warning there would be 'major consequences' for GP workload.

It found that the QRISK2 algorithm used to calculate the score gives such large weighting to age that this 10% risk threshold will eventually be exceeded in all adults – including those with no other increased risk factors.

Dependent on ethnicity, all men between the ages of 60 and 70 and all women between the ages of 65 and 75 become eligible under the revised risk threshold.

The move also means 11.8m adults aged 30-84 will be eligible to receive statins – almost two fifths of patients in that group, the researchers said.

Statin threshold

This could have ‘major consequences’ for GPs and healthcare resources to screen, treat and monitor a huge number of additional patients, they added – with each GP having to approach an estimated 200 additional patients to provide statin therapy.

The researchers entered different combination of the 15 risk factors included in the QRISK2 algorithm to estimate the 10-year CVD, then applied the NICE guidelines to sample data from the Health Survey for England 2011.

RCGP chair Professor Helen Stokes-Lampard said: ‘We need to get the risk scores right. If we find that all men over 60 and all women over 75 are going to be eligible for statins with new risk scoring, regardless of any other risk factor, then it should ring alarm bells – because it is not clear that every 60-year-old man or 75-year-old woman is going to benefit from statin therapy.

‘As with any drug, taking statin medication has potential side effects, and taking any medication long term is a substantial undertaking for patients. Many don’t want to take statins once they have learned all the facts – and GPs will respect patient choice.

‘It’s important that as new evidence becomes available, it is taken on board as guidelines for healthcare professionals are updated – but NHS resources and workforce must also be a factor.

GP workload

‘We agree with researchers that the workload implications for GPs and our teams with so many people being potentially eligible for statin therapy is enormous, so this must be matched with appropriate resources.’

Professor Mark Baker, director for the centre of guidelines at NICE said: ‘Heart disease and stroke are largely age-related, killing one in three of us and disabling many more.

‘To make progress in the battle against heart disease and stroke, we must encourage exercise, improve our diets still further, stop smoking, and where appropriate offer statins to people at risk.

‘Their use in people who have established cardiovascular disease is not controversial. Their use to prevent the development of cardiovascular disease in well people is a more recent role but is equally widespread and robustly evidence-based.'

Photo: iStock

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