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Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study.

Publication ,  Journal Article
O'Brien, EC; Greiner, MA; Xian, Y; Fonarow, GC; Olson, DM; Schwamm, LH; Bhatt, DL; Smith, EE; Maisch, L; Hannah, D; Lindholm, B; Peterson, ED ...
Published in: Circulation
October 13, 2015

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.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 13, 2015

Volume

132

Issue

15

Start / End Page

1404 / 1413

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Registries
  • Recurrence
  • Patient Readmission
  • Patient Outcome Assessment
  • Patient Discharge
  • Medicare
  • Medical Records
  • Medicaid
 

Citation

APA
Chicago
ICMJE
MLA
NLM
O’Brien, E. C., Greiner, M. A., Xian, Y., Fonarow, G. C., Olson, D. M., Schwamm, L. H., … Hernandez, A. F. (2015). Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation, 132(15), 1404–1413. https://doi.org/10.1161/CIRCULATIONAHA.115.016183

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 13, 2015

Volume

132

Issue

15

Start / End Page

1404 / 1413

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Registries
  • Recurrence
  • Patient Readmission
  • Patient Outcome Assessment
  • Patient Discharge
  • Medicare
  • Medical Records
  • Medicaid