Abstract WP261: Healthcare Utilization Patterns and Disparities in High Intensity Statin Use in Stroke Patients

Abstract

Objective: Physician adherence to evidence-based clinical guidelines improves outcomes in acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We investigated compliance with the AHA 2008 high intensity statin recommendation for secondary prevention of AIS/TIA, and factors associated with adherence. Methods: In this population-based, cohort study of incident AIS/TIA patients, we included a random sample of U.S. Medicare beneficiaries age≥67 with Part A/B/D coverage, ≥1 ICD code for AIS/TIA in 2015-2018, and no prior AIS/TIA or high intensity statin use (N=76,707). We followed the cohort forward until end of 2019 for high intensity statin use (atorvastatin ≥40mg or rosuvastatin ≥20mg). We used logistic regression to examine factors associated with high intensity statin use within 3 months: demographics, urban residence, Area Deprivation Index (ADI), and provider specialty (neurologist vs. other). Results: Overall, during follow up, only 62.5% of beneficiaries with incident AIS/TIA received neurologist care. In this period only 19.4% incident AIS/TIA patients received a high intensity statin and 27.8% did not receive any statin. Female patients (OR 0.88, 95%CI 0.84-0.92), older beneficiaries (OR 0.984, 95%CI 0.981-0.987 per year), and urban residents (OR 0.84, 95%CI 0.80-0.88) were less likely to receive a high intensity statin within 3 months of their stroke. Race/ethnicity but not ADI was associated with high intensity statin use. Neurologist-treated patients were markedly more likely to receive a high intensity statin than other AIS/TIA patients (OR 3.42, 95%CI 3.22-3.63), even after adjusting for all sociodemographic variables. Conclusions: AIS/TIA patients treated by neurologists received care consistent with the clinical guidelines more often than those not treated by a neurologist. Female, older, and urban beneficiaries were less likely to receive care consistent with the guidelines.