When to Stop Statins in Hospice Care: Benefits, Risks, and Deprescribing Guidance

Introduction

In hospice care, the focus shifts from disease prevention to improving quality of life. One decision healthcare providers commonly face is whether to discontinue statins for patients nearing the end of life. Statins, widely used for cholesterol management and long-term prevention of cardiovascular events, may no longer offer meaningful benefit when life expectancy is limited.

Clinical Rationale for Discontinuation of Statins

Statins reduce the risk of cardiovascular events over time, but those benefits typically accrue over years. For hospice patients with a prognosis of six months or less, the preventive value of statin therapy becomes negligible. Continued use may also introduce more harm than benefit due to increased risk of side effects, particularly in older adults and those with multiple comorbidities.

Statin-Associated Side Effects

Older adults and patients with renal or hepatic insufficiency, hypoxia, or electrolyte disturbances may be at higher risk for adverse effects associated with statins, including:

• Musculoskeletal pain: Statins can cause muscle-related symptoms such as myalgia, which may worsen existing weakness and fatigue common in hospice patients.
• Gastrointestinal distress: Statins can contribute to nausea, diarrhea, or other GI symptoms, further diminishing comfort.
• Rhabdomyolysis: Although rare, this severe form of muscle breakdown is more likely in patients with predisposing factors such as renal impairment. The consequences can be serious and potentially life-threatening if not addressed promptly.

Given these risks and limited expected benefit, deprescribing statins in end-of-life care is supported by evidence, including a randomized controlled trial published in JAMA (2015). The study found that discontinuing statins in patients with advanced illness improved quality of life without negatively impacting survival.

Clinical Recommendations for Deprescribing

• Evaluate prognosis: For patients with a life expectancy of less than six months, statins offer little benefit because they target long-term prevention. The clinical emphasis should shift toward symptom management and comfort.
• Engage patients and families: Providers should have open, clear conversations about the limited benefit of statins at the end of life and the potential for harm. When framed as part of comfort-focused care, deprescribing decisions are often more easily understood and accepted.
• Discontinue without tapering: In most cases, statins can be stopped immediately without tapering, allowing for a rapid reduction in pill burden and potential side effects.

Benefits of Discontinuation

• Reduction in polypharmacy: Removing statins can simplify the medication regimen and reduce unnecessary treatment burden. This is especially important for hospice patients who may already be taking several medications for symptom control.
• Improved comfort: Discontinuation can reduce muscle pain, fatigue, and gastrointestinal symptoms, contributing to better overall comfort.
• No adverse impact on survival: Evidence suggests that stopping statins in end-of-life care does not increase mortality and may improve quality of life by focusing care on what matters most.

Moving Forward

For patients with advanced illness, discontinuation of statins should be an intentional part of the deprescribing conversation. Statin-associated adverse effects, including muscle pain, gastrointestinal symptoms, and rare but serious rhabdomyolysis, are more common among older adults and those with comorbidities. Reducing unnecessary medication burden allows hospice teams to prioritize comfort, align care with patient goals, and support truly patient-centered decision-making.

By discontinuing statins, hospice teams can reduce unnecessary suffering, simplify care, lower pharmacy spend, and ensure treatment aligns with the patient’s and family’s goals for end-of-life care.

Sources

1. Adapted from Discontinuation of Statins at the End of Life, Palliative Care Network of Wisconsin.
2. Scott IA, Hilmer SN, Reeve E, et al. Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Intern Med. 2015;175(5):827–834.
3. Vollrath AM, Sinclair C, Hallenbeck J. Discontinuing Cardiovascular Medications at the End of Life: Lipid-Lowering Agents. J Palliat Med. 2005;8(4):876–881.