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Mortality fears spark statin switch rethink

Two PCTs are reviewing their implementation of Government policy on statin switching after a local audit suggested it was putting lives at risk.

Managers at North Staffordshire and Stoke-on-Trent PCTs are considering halting the policy to shift patients en masse from atorvastatin to simvastatin after signs it raised mortality in high-risk patients.

The move is likely to have national ramifications, with the Department of Health and NICE both supporting the switching of patients to the cheapest possible statin.

A Pulse survey in March found 78% of GPs were under pressure to switch patients to cheap drugs such as simvastatin.

Andrew Riley, pharmaceutical adviser at Stoke-on-Trent PCT, told Pulse this week: 'We are reviewing the guidelines. We'll look at what dose, which drugs and how long high-risk patients need to be treated.'

He stressed that the review was not just based on the audit results, adding: 'We are not jumping based on one viewpoint – we will form a considered view encompassing local GP concerns, evidence, patient choice and national guidelines.'

The local audit was conducted by Dr Rob Butler, consultant cardiologist at the University Hospital of North Staffordshire.

It looked at patients presenting with MI or unstable angina in December 2004 to February 2005, when patients were on high-dose atorvastatin, and in the same period the following year, when patients had been switched to low-dose simvastatin.

It found mortality in patients on atorvastatin was 5%, but in those on simvastatin it was 14%. The cardiac readmission rate for patients on atorvastatin was 22% higher than for patients on simvastatin.

But some local GPs have questioned the study and fear the constant switching will destabilise patients.

Dr Paul Golik, secretary of North Staffordshire LMC and a GP in Norton-in-the-Moors, Stoke on Trent, said: 'The study has upset a few people at the PCT but it needs more work.'

As a GP you have to be realistic and use the cheapest where it's safe. But there's a risk here of altering guidelines and then altering them again, which confuses everyone, not least the patient.'

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