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Item new Preprint · not peer-reviewed Added

Published rules for detecting statin intolerance agree poorly with Australian GP records

Statin intolerance was recorded in 5.09% of Australian primary-prevention statin users, and none of six published rules for detecting it from records matched a locally developed reference standard consistently.

The study implemented six published rules for detecting statin intolerance from electronic records in an Australian general-practice research network dataset. Each rule was then tested against a reference standard developed locally for that dataset. Among patients prescribed statins for primary prevention, 5.09% met the reference standard, at the lower end of the 5-15% reported in Australia and internationally. The most sensitive rule picked up 92.95% of these patients, but was correct on only 57.05% of all patients it classified. Another rule wrongly flagged almost no one, with specificity of 99.13%, and 76.19% of those it did flag met the reference standard. Agreement was weak for every rule, and the reference standard itself came from a single research network.

Why it is interesting: Rules for detecting statin intolerance from records are being proposed as the basis for prescribing decision support. Applied to the same Australian records, they picked out substantially different patients, and none matched the local reference standard.

Source
medRxiv, 12 October 2026
Paper
Electronic health record (EHR)-detectable statin intolerance phenotypes: Prevalence and validation in real-world general practice
Authors
Rakhshanda S, Rhee J, Liaw S, Rye K, Jonnagaddala J
DOI
10.1101/2025.11.04.25339533
Type
Preprint
Design
Implementation and validation of six published EHR phenotyping algorithms against a locally developed reference standard in an Australian general-practice research network dataset
Verdict
New finding
Driver
Revisions and new sources
Driver
Heart and stroke

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