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Statin therapy prescribed in less than half of stroke patients nationwide
Although the number of patients prescribed statin therapy after ischemic stroke has increased in the past decade, only 49% of U.S. patients received a statin prescription upon hospital discharge, according to new data from the large, national REGARDS study.
Researchers conducted the analysis to determine trends in post-stroke statin prescription and whether race, age and sex disparities persist in discharge statin prescribing within the U.S. Stroke Belt: Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia. While there was no difference in discharge statin prescription by race, the researchers reported differences by age and sex among those living within the Stroke Belt and in other areas of the United States.
The analysis focused on 323 participants (median age, 74 years; 46% men; 49% black; 56% residing in Stroke Belt) of the REGARDS study (> 30,000 participants). Those included were hospitalized for ischemic stroke from 2003 to 2013, were free from atrial fibrillation and were not taking statins before hospital admission. In-home examination was performed 3 to 4 weeks after an initial interview and follow-up was conducted every 6 months by telephone.
According to the findings, 48.7% of patients were prescribed a statin at discharge. The researchers described an increasing trend of discharge statin prescription for patients with ischemic stroke and no history of AF, from 23.1% in 2004 to 66.7% in 2013 (P < .001). Statin prescription was more likely to occur in patients with dyslipidemia.
Black patients living outside of the Stroke Belt were more likely to receive a statin prescription at discharge vs. white patients (RR = 1.42; 95% CI, 1.04-1.94). However, the same trend was not observed among black patients in the Stroke Belt (RR = 0.93; 95% CI, 0.69-1.26).
When the researchers examined differences by age, they found that patients aged 65 years and older who lived the Stroke Belt were less likely receive a statin prescription at discharge vs. those aged younger than 65 years from the same geographical area (RR = 0.53; 95% CI, 0.38-0.74). There was no difference by age among patients who lived outside of the Stroke Belt (RR = 1.14; 95% CI, 0.69-1.9).
When the researchers examined differences by sex, they found that men who lived in the Stroke Belt were 31% less likely to be prescribed statin therapy at discharge vs. women (RR = 0.69; 95% CI, 0.5-0.94). In contrast, more men who lived outside the Stroke Belt were more likely to receive a statin (RR = 1.38; 95% CI, 0.99-1.92).
Results were similar when the researchers included patients with AF.
“Reasons for older participants and men being discharged on a statin less frequently among Stroke Belt residents are likely multifactorial,” Karen C. Albright, PhD, DO, MPH, an advanced fellow in the Geriatric Research, Education and Clinical Center at the Birmingham VA Medical Center, Alabama, and colleagues wrote in the Journal of the American Heart Association. “Providers and family members of older individuals and men may have had different goals of care influencing their decisions regarding secondary stroke prevention. They may have had complicated hospital courses resulting from uncontrolled vascular risk factors, inpatient complications or more severe strokes leading to less aggressive inpatient stroke care.”
The researchers noted that the study has several limitations, including reliance on medical records to determine statin prescription at discharge.
However, “in patients hospitalized for stroke, opportunities exist to improve statin prescribing on discharge,” Albright said in a press release.
“All survivors of ischemic stroke should be evaluated to determine whether they could benefit from a statin, regardless of the patient’s age, race, sex or geographic residence,” Albright said. – by Darlene Dobkowski
Disclosures: Albright reports no relevant financial disclosures. Please see the full study for a list of the other authors’ relevant financial disclosures.
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One limitation of the analysis is that detailed information regarding eligibility for statin therapy were not available. A prior study (Allen NB, et al. Stroke. 2012;doi:10.1161/STROKEAHA.112.652305) found that about 60% of patients with ischemic stroke or transient ischemic attack are eligible for lipid-lowering therapy based on AHA guidelines.
Nonetheless, because patients with stroke or TIA who were receiving a statin prior to hospitalization were excluded, the current finding that only 48.7% of patients were discharged on a statin suggests that the drugs are being underutilized.
Although there was no overall difference in the use of statins in the Stroke Belt compared with other regions of the country, Stroke Belt patients aged older than age 65 years and men were less likely to receive statins compared to those in other regions. Particular attention should be directed and assuring the appropriate use of statins in these patients.