Inpatient statin use predicts improved ischemic stroke discharge disposition

Flint, Alexander C.; Kamel, Hooman; Navi, Babak B.; Rao, V.; Faigeles, Bonnie; Conell, Carol; Klingman, Jeffrey; Hills, Nancy K.; Nguyen‐Huynh, Mai N.; Cullen, Sean P.; Sidney, Stephen

doi:10.1212/wnl.0b013e3182575142

Cited by 48 publications

(54 citation statements)

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“…Exposure to statins in the acute phase of experimental stroke appears to promote angiogenesis and synaptogenesis,15 and additional pleiotropic statin effects such as vasodilatory and antithrombotic properties have been reported 16. These experimental observations are supported by clinical findings of improved outcomes with acute statin use in myocardial infarction,17, 18, 19 stroke,3, 4, 20, 21 and major vascular surgery 22, 23…”

Section: Discussionmentioning

confidence: 86%

“…Administration of statins during hospitalization for ischemic stroke is strongly associated with improved ischemic stroke outcomes, particularly when statins are administered early during stroke hospitalization 3, 4. In addition, statin withdrawal (discontinuation of a statin during stroke hospitalization among patients previously taking a statin prior to the stroke) is strongly associated with worsened stroke outcomes 3, 4, 5…”

Section: Introductionmentioning

confidence: 99%

“…In addition, statin withdrawal (discontinuation of a statin during stroke hospitalization among patients previously taking a statin prior to the stroke) is strongly associated with worsened stroke outcomes 3, 4, 5…”

Section: Introductionmentioning

confidence: 99%

“…Given the established role for statins in secondary stroke prevention1, 2 and the data supporting commencement or continuation of statins early in stroke hospitalization,3, 4, 5 our institution, a large multicenter integrated healthcare delivery system,6 deployed an electronic medical record (EMR) intervention designed to increase early statin administration during ischemic stroke hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

Flint

Conell

Klingman

et al. 2016

JAHA

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BackgroundStatin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization.Methods and ResultsThis is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an “opt‐in” to “opt‐out” mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time‐series modeling. The EMR intervention increased both overall in‐hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [P diff]=0.02, P=0.016) and discharge to home or rehabilitation facility (P diff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (P diff=0.17, P=0.033) and rate of discharge to home or rehabilitation (P diff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in‐hospital (P diff=−0.14, P=0.026).ConclusionsA simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

Flint

Conell

Klingman

et al. 2016

JAHA

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“…К сожалению, статины в регистре «ЛИС-1» не смогли продемонстрировать свое положительное влияние на прогноз вследствие низкой частоты их назначения перед референсным ИМ (око-ло 2% пациентов). Однако в другом регистре, в кото-ром участвовали пациенты с ишемическим инсультом, прием статинов как до развития инсульта, так и во вре-мя пребывания пациента в стационаре, по данным Flint AC et al, положительно повлиял на ближайший и отдаленный прогноз [16].…”

Section: Discussionunclassified

The Capabilities of a Register as a Quality Control of the Pharmacotherapy in Outpatients at High Risk of Cardiovascular Complications (The "Lis-1" Register)

Гинзбург¹,

Martsevich

Кутишенко

et al. 2014

Racionalʹnaâ farmakoterapiâ v kardiologii

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,512-0,986, р=0,040]. Статины и антиагреганты принимала очень небольшая доля больных, поэтому вклад приема этих препаратов на показатели госпиталь-ной летальности не был выявлен. Во 2-й этап исследования были включены 272 пациента, средний возраст составил 63,6±12,6 лет. Информацию о принимаемой терапии до референсной госпита-лизации сообщили 173 пациента: b-адреноблокаторы получали 39% больных, иРААС -47%, антиагреганты -37%, статины -15%, диуретики -15% больных. Че-рез 5 лет отмечались положительные изменения в частоте назначения жизненно важных препаратов: достоверное увеличение доли пациентов, получавших b-адре-ноблокаторы (p<0,001), иРААС (р<0,01), антиагреганты (p<0,05) и статины (р<0,001), доля пациентов, получавших диуретики, существенно не изменилась. Заключение. Регистр «ЛИС-1» (Люберецкое исследование смертности больных, перенесших ИМ) показал не только возможность получения данных о реальной кли-нической практике на определенном временном этапе, но также продемонстрировал возможность оценки происходящих изменений в оказании медикаментозной по-мощи пациентам с высоким и очень высоким риском сердечно-сосудистых осложнений. OR=0.542, p=0.004] and RAAS inhibitors [OR=0.710; p=0.040] prior to the development of acute myocardial infarction. As the number of patients receiving statins and antiplatelet agents was small, the contribution these drugs intake on hospital mortality was not identified. 272 patients (mean age 63.6±12.6 years) were included on the second phase of the study. The information about the received therapy before reference hospitalization was reported by 173 patients: 39% of patients used b-blockers, 47% -RAAS inhibitors, 37% -antiplatelet agents, 15% -statins, 15% of patients -diuretics. Positive changes in the frequency of the prescription of essential drugs were observed in 5 years: a significant increase in number of patients with b-blockers (p<0.001), RAAS inhibitors (p<0.01), antiplatelet agents (p<0.05) and statins (p<0.001). The number of patients with diuretics did not significantly change. Conclusion.The Register "LIS-1" (Lubertsy study of mortality in patients after myocardial infarction) allowed not only to assess data on clinical practice at a certain period, but also to evaluate the changes in drug therapy of patients with high and very high cardiovascular risk.

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Effect of Statin Use During Hospitalization for Intracerebral Hemorrhage on Mortality and Discharge Disposition

et al. 2014

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IMPORTANCE Statin use during hospitalization is associated with improved survival and a better discharge disposition among patients with ischemic stroke. It is unclear whether inpatient statin use has a similar effect among patients with intracerebral hemorrhage (ICH). OBJECTIVE To determine whether inpatient statin use in ICH is associated with improved outcomes and whether the cessation of statin use is associated with worsened outcomes. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 3481 patients with ICH admitted to any of 20 hospitals in a large integrated health care delivery system over a 10-year period. Detailed electronic medical and pharmacy records were analyzed to explore the association between inpatient statin use and outcomes. MAIN OUTCOMES AND MEASURES The primary outcome measures were survival to 30 days after ICH and discharge to home or inpatient rehabilitation facility. We used multivariable logistic regression, controlling for demographics, comorbidities, initial severity, and code status. In addition, we used instrumental variable modeling to control for confounding by unmeasured covariates at the individual patient level. RESULTS Among patients hospitalized for ICH, inpatient statin users were more likely than nonusers to be alive 30 days after ICH (odds ratio [OR], 4.25 [95% CI, 3.46-5.23]; P < .001) and were more likely than nonusers to be discharged to their home or an acute rehabilitation facility (OR, 2.57 [95% CI, 2.16-3.06]; P < .001). Patients whose statin therapy was discontinued were less likely than statin users to survive to 30 days (OR, 0.16 [95% CI, 0.12-0.21]; P < .001) and were less likely than statin users to be discharged to their home or an acute rehabilitation facility (OR, 0.26 [95% CI, 0.20-0.35]; P < .001). Instrumental variable models of local treatment environment (to control for confounding by unmeasured covariates) confirmed that a higher probability of statin therapy was associated with a higher probability of 30-day survival (with an increase in probability of 0.15 [95% CI, 0.04-0.25]; P = .01) and a better chance of being discharged to home or an acute rehabilitation facility (with an increase in probability of 0.13 [95% CI, 0.02-0.24]; P = .02). CONCLUSIONS AND RELEVANCE Inpatient statin use is associated with improved outcomes after ICH, and the cessation of statin use is associated with worsened outcomes after ICH. Given the association between statin cessation and substantially worsened outcomes, the risk-benefit balance of discontinuing statin therapy in the acute setting of ICH should be carefully considered.

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Inpatient statin use predicts improved ischemic stroke discharge disposition

Abstract: Statin use is strongly associated with improved discharge disposition after ischemic stroke.

Cited by 48 publications

References 43 publications

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

The Capabilities of a Register as a Quality Control of the Pharmacotherapy in Outpatients at High Risk of Cardiovascular Complications (The "Lis-1" Register)

Effect of Statin Use During Hospitalization for Intracerebral Hemorrhage on Mortality and Discharge Disposition

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