One in Five Stroke Patients Does Not Get Statin Therapy at Hospital Discharge
The number of stroke patients given statin prescriptions when discharged from hospitals has increased with time, but nearly one in five still leaves the hospital without the evidence-based treatment, according to a study published in Stroke: Journal of the American Heart Association.
Research has shown that patients who take the cholesterol-lowering medications after a stroke reduce their chances for having another.
"Approximately one in 10 stroke patients experience another stroke within a week," said Dr. Bruce Ovbiagele, the study's lead author and associate professor of neurology and director at UCLA Stroke Prevention Program at the UCLA Stroke Center. "The hospital encounter provides a window of opportunity to ensure prompt and appropriate initiation of treatments, such as statins, that could prevent another stroke."
In the study, researchers examined the extent to which statins were being prescribed after stroke; to whom and where they were and were not being prescribed. They also looked at whether a landmark study (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels [SPARCL] trial) proving the benefits of statin drugs in stroke prevention might have influenced the rate of statin prescription.
Researchers analyzed data on 173,284 hospitalized stroke patients from around the country, collected from January 2005 to December 2007 within the American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke nationwide quality improvement registry.
They found that 83.5 percent received statin treatment at hospital discharge. During the study period, discharge statin prescription rates climbed steadily, from 75.7 percent to 84.8 percent.
"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," Ovbiagele said. "For instance, women had 13 percent lower odds of receiving a statin compared to men, while hospitals in the South had 34 percent lower odds of discharging a stroke patient on a statin compared to hospitals in the West. While statin use after stroke improved over time, 16.5 percent of eligible stroke patients still leave the hospital without statin treatment, which unnecessarily exposes them to the risk of another stroke."
The SPARCL trial showing benefits from statins for stroke patients didn't seem to contribute to this steady rise in statin use after stroke, 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," he added.
Examining only discharges at Get With The Guidelines-Stroke hospitals could be a limitation of the study, Ovbiagele said.
"Get With The Guidelines-Stroke is a voluntary quality improvement registry, so the hospitals involved in it may be particularly motivated to provide optimal stroke care," he said. "As such, our findings may not necessarily be representative of all types of hospitals, and it is conceivable that national discharge statin treatment rates after stroke may actually be worse."
The next step is to investigate why these treatment disparities exist and how best to bridge them, Ovbiagele said.
Co-authors include Dr. Lee H. Schwamm, Dr. Eric E. Smith, Dr. Adrian F. Hernandez, DaiWai M. Olson, Wenqin Pan, Dr. Gregg C. Fonarow, and Dr. Jeffrey L. Saver. Author disclosures are on the manuscript.
The UCLA Stroke Center is recognized as one of the world's leading centers for the management of cerebral vascular disease. The center treats simple and complex vascular disorders by incorporating recent developments in emergency medicine, stroke neurology, microneurosurgery, interventional neuroradiology, stereotactic radiology, neurointensive care, neuroanesthesiology and rehabilitation neurology. UCLA's stroke program is unique in its ability to integrate clinical and research activities across multiple disciplines and departments. Founded in 1994, the UCLA Stroke Center is designated as a certified Primary Stroke Center by the national Joint Commission on Accreditation of Healthcare Organizations.