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Statin Treatment and Ischemic Stroke Outcomes
Study Questions:
What is the association between statin prescription at hospital discharge, long-term clinical outcomes, and patient-centered outcomes in a cohort of patients who were not taking statins at the time of admission for ischemic stroke?
Methods:
PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate effectiveness of post-stroke therapies. The investigators linked data on patients ≥65 years of age enrolled in the Get With the Guidelines (GWTG)-Stroke Registry to Medicare claims. Two-year post-discharge outcomes of those discharged on a statin versus not were adjusted using inverse probability weighting. The coprimary outcomes were: 1) major adverse cardiovascular events (MACE), and 2) home-time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke.
Results:
From 2007–2011, 77,468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard (hazard ratio; 95% confidence interval) of MACE (0.91; 0.87, 0.94), 28 more home-time days following discharge (p < 0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (0.94; 0.72, 1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had similar outcomes compared with moderate-intensity recipients.
Conclusions:
The authors concluded that in older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of MACE and nearly a month more home-time during the 2-year period post-hospitalization.
Perspective:
This study examined the association between discharge statin use, statin intensity, clinical outcomes, and patient-centered outcomes in a real-world population of older ischemic stroke patients. It reports that discharge statin therapy was associated with a lower adjusted risk of MACE and lower risk of all-cause mortality during the 2-year period following hospitalization. Furthermore, discharge statins significantly improved home-time for patients, with 28 additional days at home over 2 years, and the observed benefits were consistent across clinically relevant subgroups. The study also found that compared with low/moderate-intensity statins, high-intensity statin use did not improve clinical outcomes or days spent at home in the 2 years after discharge. This analysis addresses a key knowledge gap by focusing on patient-centered outcomes in a real-world stroke population, and suggests that every stroke patient should be discharged on statins unless contraindicated.
Keywords: Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hemorrhage, Lipids, Patient Readmission, Risk, Secondary Prevention, Stroke, Treatment Outcome
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