Abstract WP337: Age and Race Disparities in Statin Prescribing Persist Following Discharge for Stroke or Transient Ischemic Attack

Abstract

Introduction: Prescribing of high intensity statins (atorvastatin 40-80mg/d, rosuvastatin 20-40mg/d) following acute stroke and anti-coagulants in the subgroup with atrial fibrillation (AF) result in reduced risk for a second stroke. Recent data suggests that high intensity statins are less often prescribed for older patients and real-world data are limited for direct-acting oral anti-coagulants (DOAC). The present study examines discharge prescribing patterns for these medications by age and race from a prospective trial in 41 hospitals in North Carolina. Methods: Data are from the Comprehensive Post-Acute Stroke Services Study, a cluster-randomized trial of transitional care for adult stroke or TIA patients discharged directly home after hospital discharge. Analyses included 3787 patients [mean age 66 yrs., 47% female; 30% non-white] linked to the Get-with-the-Guidelines (GWTG) database. Prescribing of intensive statin therapy as well as rivaroxaban or apixaban vs. warfarin in those with a history of AF was abstracted, and was compared by age (< 65 vs. ≥ 65yr.), race (white vs. non-white) and gender. Odds ratios were obtained from logistic mixed models with a random intercept for hospital. Results: Among 3096 patients prescribed statin therapy at discharge, 61% were prescribed intensive statin therapy. Patients who were ≥ 65yr. had significantly lower odds of intensive statin therapy prescription than younger patients (OR=0.54, 95% CI 0.45-0.65); results were similar across all sex-race subgroups. Among 366 patients with a history of AF who were prescribed an anti-coagulant at discharge, 72% were prescribed rivaroxaban or apixaban. Among 254 patients ≥ 65yr., 26 of 39 non-white patients (67%) vs. 156 of 215 white patients (73%) were prescribed rivaroxaban or apixaban [p=0.29]. Conclusion: Intensive statin therapy following mild stroke or TIA is significantly less common in older patients compared with those under age 65. Among patients ≥65yr. with a history of AF and acute stroke, there was minimal difference by race in rivaroxaban or apixaban prescribing. Prescription fills/refills and adherence should be further explored in these patients.