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To the Editor: Using an observational study approach, Dr Go and colleagues¹ report that the use of statin therapy in patients with heart failure resulted in a 24% and a 21% reduction in the rates of death and hospitalization, respectively. These findings may be subject to immortal time bias.^2-3

In the study cohort, the time span between the date of cohort entry (the date of the "first qualifying diagnosis" of heart failure) and the date of the first statin prescription is called immortal. This is because a patient had to remain alive to receive a statin prescription sometime during follow-up. The patients who died before receiving a prescription ended up in the "no statin" group. Consequently, the patients in the statin group have a guaranteed survival advantage that results in an artifactually lower mortality rate in the statin-exposed participants.

The authors use an intent-to-treat approach with the Cox proportional hazards . . . [Full Text of this Article]

Samy Suissa, PhD
samy.suissa@clinepi.mcgill.ca
Division of Clinical Epidemiology
McGill University
Montreal, Quebec

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Statin Use and Risks for Death and Hospitalization in Chronic Heart Failure
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Statin Therapy and Risks for Death and Hospitalization in Chronic Heart Failure
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