1 in 5 Stroke Patients Still Not Prescribed Statins at Discharge

From Medscape Medical News
Janis C. Kelly

June 24, 2010 — Current guidelines call for in-hospital initiation of statin therapy for patients with stroke or transient ischemic attack (TIA) of atherosclerotic origin and continuing statin therapy in stroke patients at the time of discharge.

However, a new study finds that 1 in 5 of these patients is still not prescribed statins at hospital discharge and that reports from clinical trials documenting the effectiveness of statins in secondary stroke prevention apparently had no lasting impact on clinical practice.

"Approximately 1 in 10 stroke patients experience another stroke within a week," said lead study author Bruce Ovbiagele, MD, MsC, director of the UCLA Stroke Prevention Program at the University of California, Los Angeles.
"The hospital encounter provides a window of opportunity to ensure prompt and appropriate initiation of treatments, such as statins, that could prevent another stroke."

The study was published online May 27 and will appear in the July issue of Stroke: Journal of the American Heart Association.

Before and After SPARCL


Dr. Bruce Ovbiagele
Dr. Ovbiagele and colleagues used data from patients admitted to hospitals participating in Get With the Guidelines–Stroke (GWTG-Stroke) to assess trends in discharge statin treatment and to see whether such treatment changed in response to dissemination of results from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. They also analyzed factors that might predict whether patients would get statins or not.

The researchers analyzed data on 173,284 hospitalized stroke patients from around the country, collected from January 2005 to December 2007. They found that 83.5% received statin treatment at hospital discharge.

During the study period, discharge statin prescription rates climbed "steadily but modestly," they write, from 75.7% to 84.8%. They also found a slight bump upward in statin prescriptions during the time the SPARCL data were being widely reported, but rates soon returned to prior levels.

Interestingly, academic hospitals and hospitals in the South or Midwest were less likely to adhere to the guidelines and give patients discharge statin prescriptions. The researchers note that their "finding that academic hospitals participating in GWTG-Stroke were less likely to implement discharge statin treatment when compared with nonacademic hospitals was not consistent with prior data" and suggest this may reflect differences between theirs and the previous population samples but "will require further study.

"We found that several individual and hospital level factors were linked to not receiving a statin at the time of hospital discharge after a stroke," Dr. Ovbiagele said. "For instance, women had 13% lower odds of receiving a statin compared to men, while hospitals in the South had 34% lower odds of discharging a stroke patient on a statin compared to hospitals in the West."

Patients who presented with TIA rather than ischemic stroke, who had known coronary artery disease, or who had known peripheral vascular disease were also less likely to receive discharge statin prescriptions.

"While statin use after stroke improved over time, 16.5% of eligible stroke patients still leave the hospital without statin treatment, which unnecessarily exposes them to the risk of another stroke," Dr. Ovbiagele said. "Nationwide quality improvement programs like Get With the Guidelines–Stroke may not only serve to boost overall evidence-based treatment in stroke patients but can also help specifically pinpoint those patients or hospitals that might require additional efforts to improve stroke care."

The GWTG study was funded in part by grants to the American Heart Association from Pfizer Inc and the Merck-Schering Plough Partnership. Dr. Ovbiagele has disclosed no relevant financial relationships.

Stroke. Published online May 27, 2010.