Patterns and predictors of discharge statin prescription among hospitalized patients with intracerebral hemorrhage.
OBJECTIVE
Many patients hospitalized with intracerebral hemorrhage are at high future risk for ischemic events and may benefit from stain therapy. However, little is known about patterns of statin prescription among patients with intracerebral hemorrhage, especially after the finding of higher hemorrhagic stroke risk in the statin treatment arm of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. We evaluated recent nationwide trends in discharge statin treatment after intracerebral hemorrhage hospitalization.


METHODS
Using data from 25 673 patients with hemorrhagic stroke admitted to Get With Guidelines-Stroke participating hospitals between January 1, 2005, and December 31, 2007, we assessed factors associated with discharge statin prescription, including treatment over time and in relation to dissemination of the SPARCL results. Piecewise logistic multivariable regression models were fit to track statin use in various periods.


RESULTS
Mean age was 67.9±15 years, 48.1% female, and discharge statin treatment in 39.5%. Variables independently associated with lower discharge statin use included female sex (OR 0.87, 95% CI, 0.82 to 0.93), prior stroke/transient ischemic attack (OR 0.85, 95% CI, 0.78 to 0.92), academic center (OR 0.87, 95% CI, 0.82 to 0.93), and Midwest region (OR 0.65, 95% CI, 0.56 to 0.80). Statin prescription climbed over the study period from 66.9% to 74.5% (P<0.001) among eligible patients with a decrease during SPARCL reporting (P=0.03) and then a return to prior levels thereafter.


CONCLUSIONS
Discharge statin prescription among hospitalized patients with intracerebral hemorrhage has modestly risen over time. The clinical implications of this care pattern among patients with intracerebral hemorrhage require further study.
Ovbiagele
Bruce
B
Department of Neurology (B.O., J.L.S.), UCLA Medical Center, Los Angeles, Calif 90095, USA. Ovibes@mednet.ucla.edu
Schwamm
Lee H
LH
Smith
Eric E
EE
Hernandez
Adrian F
AF
Olson
DaiWai M
DM
Pan
Wenqin
W
Fonarow
Gregg C
GC
Saver
Jeffrey L
JL
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors