Abstract 285: Do Providers Prescribe Statins to Patients Diagnosed with Carotid Artery Stenosis in Adherence with the AHA/ASA Stroke Prevention Guidelines?

Abstract

Background: Patients with carotid artery stenosis (CAS)≥ 50% have an annual stroke risk of 1-2% and an annual cardiac-related mortality approaching 3% .The 2014 AHA/ASA stroke prevention guidelines provide a class I recommendation that patients diagnosed with CAS be prescribed a statin as part of optimal medical management. Recent data shows that approximately 70% of patients with CAS≥ 50% report not receiving a statin prescription. The aim of this study was to examine whether patients with CAS ≥ 50% are prescribed statins at 6 months after diagnosis by duplex ultrasound. Methods: We reviewed carotid duplex ultrasound studies performed at Thomas Jefferson University for various indications from 2/2017 to 3/2018 and identified studies reporting either unilateral or bilateral CAS≥ 50%. We obtained the patient identification and medication list at the time of the ultrasound. We then queried the electronic medical record for the patient active medication list at 6 months after the ultrasound. Results: Carotid ultrasounds of 411 patients were reviewed. 105 patients were found to have CAS ≥ 50%. 87% (91 of 105) of these patients had hypertension and 80% (84 of 105) had hyperlipidemia. 24% (25 of 105) of these patients had a history of stroke. 79% (83 of 105) had a statin prescription prior to ultrasound diagnosis. Of the patients without a statin prescription, 31% (7 of 22) were prescribed a statin by 6 months after ultrasound diagnosis. 81% (85 of 105) of patients with CAS ≥ 50% had an active statin prescription at 6 months after ultrasound diagnosis. 53% (45 of 85) of prescriptions at 6 months were for high-intensity statins. Vascular surgery, primary care, and cardiology were the most common prescriber specialties with 34% (20 of 75) of prescriptions ordered by providers from other medical specialities. Conclusion(s): In a single institution sample, the majority of patients with unilateral or bilateral carotid artery stenosis ≥ 50% are prescribed statins prior to diagnosis by duplex ultrasound and at 6 months after diagnosis by duplex ultrasound. The intensity of the statin prescribed, as well as the medical specialty of the prescriber, vary.