Statin Use During Ischemic Stroke Hospitalization Is Strongly Associated With Improved Poststroke Survival

Flint, Alexander C.; Kamel, Hooman; Navi, Babak B.; Rao, V.; Faigeles, Bonnie; Conell, Carol; Klingman, Jeff; Sidney, Stephen; Hills, Nancy K.; Sorel, Michael; Cullen, Sean P.; Johnston, S. Claiborne

doi:10.1161/strokeaha.111.627729

Cited by 136 publications

(107 citation statements)

References 31 publications

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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%

“…All included subjects had serial documentation of the mNIHSS according to a standardized regional protocol (across all hospitals), so all subjects in the cohort had multiple mNIHSS measurements available to determine change in mNIHSS. Information on death was determined from Kaiser Permanente Northern California database information supplemented by California Death Certificates database information linked probabilistically to the subject based on the subject's name, birth date, social security number, sex, and residence 3. We examined administration of inpatient statins (defined as administration at any time during the inpatient stay) and early administration of inpatient statins (defined as administration within 8 hours of ER triage time).…”

Section: Methodsmentioning

confidence: 99%

“…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: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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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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Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia

Gao,

Jiang,

Pan

et al. 2024

JAMA Neurol

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ImportanceComparisons are limited for immediate-intensive and delayed-intensive statin for secondary stroke prevention and neuroprotection in patients with acute mild ischemic stroke or transient ischemic attack (TIA) from atherosclerosis.ObjectiveTo estimate whether immediate-intensive statin therapy is safe and can lower the risk of recurrent stroke compared with delayed-intensive statin in patients with acute mild ischemic stroke or high-risk TIA from atherosclerosis.Design, Setting, and ParticipantsThe Intensive Statin and Antiplatelet Therapy for High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, a double-blind, placebo-controlled, 2 × 2 factorial, randomized clinical trial enrolled patients from September 2018 to October 2022. The trial was conducted at 222 hospitals in China. Patients aged 35 to 80 years with mild ischemic stroke or high-risk TIA of presumed atherosclerosis within 72 hours of symptom onset were assessed.InterventionsPatients were randomly assigned to receive immediate-intensive atorvastatin (80 mg daily on days 1-21; 40 mg daily on days 22-90) or 3-day delayed treatment (placebo for days 1-3, followed by placebo and atorvastatin, 40 mg daily on days 4-21, and then atorvastatin, 40 mg daily on days 22-90).Main Outcomes and MeasuresThe primary efficacy outcome was new stroke within 90 days, and a secondary efficacy outcome was poor functional outcome. Moderate to severe bleeding was the primary safety outcome.ResultsA total of 11 431 patients were assessed for eligibility, and 6100 patients (median [IQR] age, 65 [57-71] years; 3915 men [64.2%]) were enrolled, with 3050 assigned to each treatment group. Within 90 days, new stroke occurred in 245 patients (8.1%) in the immediate-intensive statin group and 256 patients (8.4%) in the delayed group (hazard ratio, 0.95; 95% CI, 0.80-1.13). Poor functional outcome occurred in 299 patients (9.8%) and 348 patients (11.4%) in the immediate-intensive and delayed-intensive statin groups, respectively (odds ratio, 0.83; 95% CI, 0.71-0.98). Moderate to severe bleeding occurred in 23 of 3050 patients (0.8%) and 17 of 3050 patients (0.6%), in the immediate-intensive and delayed-intensive statin groups, respectively.Conclusions and RelevanceImmediate-intensive statin initiated within 72 hours did not reduce the risk of stroke within 90 days and may be associated with improved functional outcomes without significant difference in moderate to severe bleeding, compared with 3-day delayed-intensive statin in Chinese patients with acute mild ischemic stroke or TIA from atherosclerosis.Trial RegistrationClinicalTrials.gov Identifier: NCT03635749

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Statin Use During Ischemic Stroke Hospitalization Is Strongly Associated With Improved Poststroke Survival

Abstract: Background and Purpose-Statins reduce infarct size in animal models of stroke and have been hypothesized to improve clinical outcomes after ischemic stroke. We examined the relationship between statin use before and during stroke hospitalization and poststroke survival.

Cited by 136 publications

References 31 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

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

Immediate- or Delayed-Intensive Statin in Acute Cerebral Ischemia

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