Background and Purpose-National guidelines recommend lipid testing for all patients with ischemic stroke and transient ischemic attack. This study examined the frequency and predictors for in-hospital low-density lipoprotein testing using data from a nationwide stroke registry. Key Words: cholesterol Ⅲ health services research Ⅲ ischemic stroke Ⅲ LDL Ⅲ stroke Ⅲ transient ischemic attack L ipid testing and treatment is well established for secondary prevention of ischemic cardiovascular and cerebrovascular disease. Studies show that HMG-CoA reductase inhibitors (statins) prevent ischemic stroke in persons with dyslipidemia, coronary heart disease, or stroke. 1,2 A recent meta-analysis of randomized trials of statins, including Ͼ165 000 individuals, showed that each 39-mg/dL decrease in low-density lipoprotein (LDL) decreased the relative risk for stroke by 21.1%. 1 Most of these patients did not have a history of stroke or transient ischemic attack (TIA) at the time of enrollment, however. The recent Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that patients with stroke randomized to 80 mg atorvastatin per day had fewer recurrent strokes as well as a substantially fewer coronary events. 3 The American Heart Association/American Stroke Association (AHA/ASA) advises in-hospital lipid testing with initiation of statin therapy for most patients with ischemic stroke and TIA with elevated cholesterol, comorbid coronary artery disease, or stroke or TIA of atherosclerotic origin. 4 -6 Previous stroke registries show that many hospitalized patients with ischemic stroke do not receive adequate investigation for modifiable risk factors. 7 In particular, prior studies show that lipid levels are not tested in many patients despite the accumulating evidence that lipid management is important for stroke prevention 8,9 and guidelines that recommend lipid testing in hospitalized patients with stroke. 6,10 There are few data on patient and hospital characteristics predictive of lipid testing in patients hospitalized with ischemic stroke and TIA. Furthermore, little is known on whether lipid testing is increasing in patients hospitalized with stroke, especially given the recent changes in clinical guidelines.
Methods-BetweenThe Get With The Guidelines-Stroke (GWTG-Stroke) program is a national stroke registry and quality improvement program designed to foster better adherence to guidelinebased stroke care in patients hospitalized with stroke and
Methods Subject Population and Study MeasurementsThe GWTG-Stroke program has been previously described. 7,11 Participating hospitals use an Internet-based Patient Management Tool (Outcome Sciences Inc, Cambridge Mass) to enter data, receive decision support, and obtain feedback through on-demand reports of performance on quality measures. One of the 7 key performance measures of the GWTG-Stroke program is discharge on LLT based on existing AHA/ASA and National Cholesterol Education Panel Adult Treatment Panel III (NCEP-ATPIII) guidelines. ...