Nationwide Study Shows Improvements and Shortcomings in Prescribing Statins to Stroke Patients at Hospital Discharge

 

August 10, 2017—The American Heart Association (AHA) recently announced publication of a study showing that in the United States, less than half of stroke patients discharged from the hospital received a prescription for a statin, and the likelihood of a prescription varied by the patient's geographic location, sex, age, and race. Follow‐up findings from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study were published by Karen Albright, PhD, DO, MPH, et al online in Journal of the American Heart Association.

According to the AHA, compared to other areas, death from stroke is more common in the "Stroke Belt" of the southeastern United States: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia. Previous studies have shown, however, that statin prescriptions are lower among stroke patients discharged in the south and among women, older, and black patients.

In this study, the investigators compared statin use between different groups of patients with ischemic stroke, both in and outside the Stroke Belt, to evaluate the magnitude of these differences by age, sex, and race.

The investigators reported that 49% of stroke patients received a prescription for statins at hospital discharge, and the percentage of patients receiving prescriptions increased over the course of the 10-year study.

The key comparisons of the study included:

  • Patients aged ≥ 65 years were 47% less likely than younger patients to receive statins in the Stroke Belt versus no difference in states outside the Stroke Belt.
  • Men in the Stroke Belt were 31% less likely than women to receive statins. Outside the Stroke Belt, men were 38% more likely than women to receive statins.
  • There was no difference by race in statin prescription in the Stroke Belt. Outside the Stroke Belt, blacks were 42% more likely than whites to receive statins.

The investigators looked at demographic and health information, including stroke risk factors, for 323 stroke patients participating in a national study of more than 30,000 adults in the United States aged ≥ 45 years from 2003 to 2013. The study used computer-assisted telephone interviews, questionnaires, an in-home examination, and medical records from the stroke hospitalization and discharge.

The AHA advised that the study relied upon medical records for use of statins, which could have led to incorrect estimates of the number of statin users. Another limitation is that it only included patients who reported that they were not taking a statin when admitted to the hospital, which could have also affected the study’s results.

According to the AHA/American Stroke Association "Get With the Guidelines–Stroke" database, this quality improvement initiative has helped participating hospitals increase the adherence to statin prescribing guidelines significantly over the past 10 years, from 61.6% in 2003 to 97.8% in 2016, noted the AHA.

 

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