title: Inpatient statin use predicts improved ischemic stroke discharge disposition.
abstract: OBJECTIVE
  To determine whether statin use is associated with improved discharge disposition after ischemic stroke.
  
  
  METHODS
  We used generalized ordinal logistic regression to analyze discharge disposition among 12,689 patients with ischemic stroke over a 7-year period at 17 hospitals in an integrated care delivery system. We also analyzed treatment patterns by hospital to control for the possibility of confounding at the individual patient level.
  
  
  RESULTS
  Statin users before and during stroke hospitalization were more likely to have a good discharge outcome (odds ratio [OR] for discharge to home = 1.38, 95% confidence interval [CI] 1.25-1.52, p < 0.001; OR for discharge to home or institution = 2.08, 95% CI 1.72-2.51, p < 0.001). Patients who underwent statin withdrawal were less likely to have a good discharge outcome (OR for discharge to home = 0.77, 95% CI 0.63-0.94, p = 0.012; OR for discharge to home or institution = 0.43, 95% CI 0.33-0.55, p < 0.001). In grouped-treatment analysis, an instrumental variable method using treatment patterns by hospital, higher probability of inpatient statin use predicted a higher likelihood of discharge to home (OR = 2.56, 95% CI 1.71-3.85, p < 0.001). In last prior treatment analysis, a novel instrumental variable method, patients with a higher probability of statin use were more likely to have a good discharge outcome (OR for each better level of ordinal discharge outcome = 1.19, 95% CI 1.09-1.30, p = 0.001).
  
  
  CONCLUSIONS
  Statin use is strongly associated with improved discharge disposition after ischemic stroke.
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA. alexander.c.flint@kp.org
authors.forename: A C
authors.initials: AC
authors.lastname: Flint
authors.forename: H
authors.initials: H
authors.lastname: Kamel
authors.forename: B B
authors.initials: BB
authors.lastname: Navi
authors.forename: V A
authors.initials: VA
authors.lastname: Rao
authors.forename: B S
authors.initials: BS
authors.lastname: Faigeles
authors.forename: C
authors.initials: C
authors.lastname: Conell
authors.forename: J G
authors.initials: JG
authors.lastname: Klingman
authors.forename: N K
authors.initials: NK
authors.lastname: Hills
authors.forename: M
authors.initials: M
authors.lastname: Nguyen-Huynh
authors.forename: S P
authors.initials: SP
authors.lastname: Cullen
authors.forename: S
authors.initials: S
authors.lastname: Sidney
authors.forename: S C
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007297:Inpatients; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors