Real-world evidence on In-hospital statin use and mortality in geriatric patients

BACKGROUND: The role of statins in individuals older than 75 years, particularly those with frailty, remains unclear. Recent studies suggest survival benefits of chronic statin use, independent of cardiovascular status. However, survival effects of statins during acute hospitalisation in geriatric patients are unknown. OBJECTIVE: To examine the association between in-hospital statin exposure and all-cause in-hospital mortality among patients admitted to an acute geriatric ward. METHODS: A retrospective observational cohort study of patients ≥ 75 years admitted to a geriatric ward was conducted between 9 December 2022 and 24 July 2023. Exposure was defined as statin administration on day 2 after admission. Patients were followed until death or discharge. The outcome was in-hospital all-cause mortality. Multivariable logistic regression models were adjusted for age, sex, comorbidity burden, and functional status measured by handgrip strength. Sensitivity analyses included additional adjustment for, or stratification by, prior atherosclerotic cardiovascular disease (ASCVD) and systemic inflammation assessed by C-reactive protein (CRP). RESULTS: Among 545 patients, in-hospital statin use was associated with a 6.3% absolute risk reduction or 49% adjusted odds reduction (OR 0.5, 95% CI [0.3-1.0]) for in-hospital mortality compared with non-use. Additional adjustment for ASCVD (OR 0.5, 95% CI [0.3-1.1]) or CRP (OR 0.6, 95% CI [0.3-1.2]) yielded similar results. Mortality reductions were comparable in secondary and primary prevention subgroups (OR 0.5 and 0.6, respectively). No significant interactions were observed. CONCLUSIONS: In-hospital statin exposure was associated with lower in-hospital mortality among acutely hospitalised older adults. Prospective randomized studies are warranted to assess causality and inform clinical practice.