Abstract P288: Statin Prescription Patterns at Discharge among Ischemic Stroke Patients. The North Carolina Stroke Care Collaborative

Abstract

Background: Current American Heart Association/American Stroke Association guidelines recommend in-hospital initiation of statin therapy for stroke patients at the time of hospitalization and at discharge. Nationwide data suggest that despite a favorable trend of increased prescribing of statins at discharge, the overall proportion of stroke patients discharged with statin therapy is significantly below the guideline recommendations. Study aim: To evaluate statin prescribing patterns at discharge for patients hospitalized for ischemic stroke in 56 North Carolina (NC) hospitals participating in the NC Stroke Care Collaborative (NCSCC). Methods: We used data on ischemic stroke admissions in 2008 through 2011 to hospitals affiliated with the NCSCC. Of the total n=39,345 stroke admissions, 23,643 (60%) were admissions for ischemic stroke, as ascertained from ICD-9 discharge codes. Excluded from analysis were stroke admissions that resulted in transfer to another hospital (n=346), patients on observation (n=105) and comfort care only (n=589), patients who died prior to discharge (n=926), those whose hospital visit did not result in admission (n=9), those missing information on statin prescription at discharge (n=3,402), and those with a documented reason for not prescribing statin therapy at discharge (n=675). The final sample size was 19,064 ischemic stroke events. Linear and logistic regression models were used to evaluate factors associated with statin prescribing patterns. Results: Documented statin prescription at discharge varied by age, with the highest proportion of prescriptions registered for stroke patients aged 56-65 years (86%). Statin prescribing at discharge was significantly (p<0.01) lower among patients< 56 years (81%) and those >65 years of age (77%). After adjusting for age, factors associated with low statin prescribing in this population were female gender, small hospital bedsize, academic affiliation of the hospital, and rural location of the hospital. Medical history of dyslipidemia and evidence of lipid lowering medication at admission were positive predictors of statin prescribing at discharge. Conclusions: We observed an age-dependent pattern of statin prescribing at discharge for patients in hospitals affiliated with the NCSCC. The lower proportion of hospitalized ischemic patients over 65 years of age that are discharged on statin therapy compared to those younger is consistent with reports from other studies. The relatively low proportion of patients younger than 56 years with statin prescription at discharge requires further investigation.