Less than 50% of stroke patients discharged from the hospital were given a prescription for statins, and statin discharge prescribing varied greatly among Stroke Belt and non-Stroke Belt residents, particularly in men and older patients, according to a recent analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. These results were published in the Journal of the American Heart Association.
Estimates suggest that 80% of recurrent strokes could be prevented through a combination of lifestyle changes and adherence to secondary stroke prevention medications. A previous meta-analysis of placebo-controlled and active-comparator trials showed that statins reduce the risk of stroke in patients with coronary heart disease, while a randomized, controlled trial demonstrated that treatment with statins reduces the risk for recurrent stroke in patients with a history of stroke or transient ischemic attack.
“All ischemic, or non-bleeding, stroke survivors should be evaluated to determine whether they could benefit from a statin, regardless of the patient’s age, race, sex or geographic residence,” said lead author Karen Albright, PhD, DO, recent doctoral graduate, department of epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL. “In patients hospitalized for ischemic stroke, opportunities exist to improve statin prescribing upon discharge.”
During a follow-up of the REGARDS study, Dr. Albright and fellow researchers analyzed discharge medications given to subjects hospitalized for an ischemic stroke. They abstracted medications on admission and discharge from medical records for 323 subjects who were not statin users at the time of admission with no history of atrial fibrillation.
In all, 48.7% of subjects were prescribed a statin upon discharge. In the Stroke Belt—an area of the southeastern United States—subjects who were aged ≥ 65 years were 47% less likely to be discharged on a statin compared with those < 65 years (RR: 0.53; 95% CI: 0.38, 0.74). Researchers did not find this association in subjects who were not in the Stroke Belt.
Furthermore, they found that outside the Stroke Belt, black subjects were more likely than whites to be discharged on a statin (RR: 1.42; 95% CI: 1.04, 1.94), and there was no black:white association in Stroke Belt residents (RR: 0.93; 95% CI: 0.69, 1.26; P for interaction=0.228).
Compared with women, men in the Stroke Belt were 31% less likely to be discharged on a statin (RR: 0.69; 95% CI: 0.50, 0.94), while men outside the Stroke Belt were more likely to be discharged on a statin (RR: 1.38; 95% CI: 0.99, 1.92; P for interaction=0.004).
“Our findings should raise questions about why so few patients get this evidence-based medication at the time of discharge and highlight variations in care by geography that may be contributing to recurrent stroke disparities,” concluded senior author Justin Blackburn, PhD, associate professor, department of health care organization and policy, University of Alabama at Birmingham.