Emily C O'Brien1, Melissa A Greiner2, Ying Xian2, Gregg C Fonarow2, DaiWai M Olson2, Lee H Schwamm2, Deepak L Bhatt2, Eric E Smith2, Lesley Maisch2, Deidre Hannah2, Brianna Lindholm2, Eric D Peterson2, Michael J Pencina2, Adrian F Hernandez2. 1. From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution. emily.obrien@duke.edu. 2. From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
Abstract
BACKGROUND: In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. METHODS AND RESULTS: Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (P<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. CONCLUSION: In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization.
BACKGROUND: In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. METHODS AND RESULTS:Patient-Centered Research Into Outcomes StrokePatients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (P<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. CONCLUSION: In older ischemic strokepatients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization.
Authors: Susan Redline; Si Baker-Goodwin; Jessie P Bakker; Matthew Epstein; Sherry Hanes; Mark Hanson; Zinta Harrington; James C Johnston; Vishesh K Kapur; David Keepnews; Emily Kontos; Andy Lowe; Judith Owens; Kathy Page; Nancy Rothstein Journal: J Clin Sleep Med Date: 2016-07-15 Impact factor: 4.062
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