Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Ovbiagele, Bruce; Schwamm, Lee H.; Smith, Eric E.; Hernandez, Adrian F.; Olson, DaiWai M.; Pan, Wenqin; Fonarow, Gregg C.; Saver, Jeffrey L.

doi:10.1161/strokeaha.109.573618

Cited by 41 publications

(47 citation statements)

References 26 publications

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“…The increasing use of antihyperlipidemic therapy in patients with coronary artery disease and stroke has resulted in a reduction in total atherosclerosis burden. 13,14 Furthermore, there has been a reported growth in the use of physiological screening tools for peripheral arterial disease, 15 which may allow earlier identification of individuals with subclinical critical limb ischemia. The positive impact of surveillance imaging programs on graft patency has also been recognized.…”

Section: Discussionmentioning

confidence: 99%

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Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

et al. 2013

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Background-Epidemiology data for lower-extremity arterial thromboembolism (LET) are limited and may result from either acute limb ischemia or an acute exacerbation of critical limb ischemia. Given marked changes in both diagnosis and therapy over the last 2 decades, we hypothesized that this time period would have witnessed reductions in both the incidence and in-hospital mortality of LET. Methods and Results-Data from 1988 through 2007 from the National Hospital Discharge Survey were analyzed. All admissions for patients with LET were extracted, and the respective International Classification of Diseases, Ninth Revision, Clinical Modification codes were internally validated for both LET and acute limb ischemia. Descriptive statistics were used. The validity of the codes was good for identifying LET cases but poor for identifying acute limb ischemia cases because many of these acute presentations were attributable to critical limb ischemia. Over the 20-year span, there were 1.76 million cases of LET. The incidence of LET decreased significantly from 42.4 per 100 000 persons between 1988 and 1997 to 23.3 per 100 000 persons between 1998 and 2007. The in-hospital mortality for LET decreased significantly from 8.28% between 1988 and 1997 to 6.34% between 1998 and 2007, and male patients achieved greater mortality reduction compared with female patients. Treatments for acute limb ischemia showed decreasing use of surgical bypass and amputation and increasing rates of catheter-based thrombolysis. Conclusions-Over the 20-year study period, there have been significant reductions in both LET incidence and in-hospital mortality. Unfortunately, LET admissions extracted from an administrative database comprise a diverse group of individuals, including those with acute and chronic forms of limb ischemia and iatrogenic arterial injury, limiting the true assessment of ALI incidence. .).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

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Section: Discussionmentioning

confidence: 99%

“…The rates of surgical bypass showed a significant reduction between the first and second decades (36.6% versus 29.6%, respectively; P<0.0001), whereas the rates of catheter-based thrombolysis increased significantly for the same decade comparison (4.6% versus 7.1%, respectively; Age, mean (SD), y* 68 (14) 66 (13) 70 (14) 67 (14) 65 (14) 70 ( …”

Section: Methodsmentioning

confidence: 99%

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

et al. 2013

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“…For example, statin medications (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are among the most commonly used medications for secondary prevention of ischemic stroke. [20][21][22][23] Several observational studies in nonstroke patient populations have reported a protective effect for statins in that prior use results in reduced risk for developing an infection. [24][25][26][27] These results are interpreted to indicate that immunomodulation and peripheral anti-inflammatory properties are among the beneficial pleiotropic actions of statins that may inhibit a proinflammatory environment favoring infection.…”

Section: Introductionmentioning

confidence: 99%

Statin Medication Use and Nosocomial Infection Risk in the Acute Phase of Stroke

Weeks

Greer

Willson

2016

Journal of Stroke and Cerebrovascular Diseases

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“…When office blood pressure values were examined no significant differences were observed between PCP encounters and neurologist encounters suggesting that either blood pressure level during was not the main driver of the higher antihypertensive drug use seen among PCPs or patient blood pressure levels were higher in the PCP group thereby stimulating a higher treatment rate. While several studies have reported that neurologist’s management, compared with generalist’s management, is associated with improved patient outcomes among hospitalized stroke patients, 18-22 and there are data on the influence of recent clinical trials on inpatient treatment rates, 23 few comparisons have been conducted in the ambulatory care setting. 24 Patients and neurologists seem to generally perceive that neurologic outpatient involvement adds value to care, 25 but more objective data to support this notion are lacking.…”

Section: Discussionmentioning

confidence: 99%

Trends in Antihypertensive Drug Prescription Patterns among Ambulatory Stroke Patients in the United States, 2000-2009

Ovbiagele

Ernström

Markovic

et al. 2013

Journal of Stroke and Cerebrovascular Diseases

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Background While the ambulatory setting is recognized as the best arena for optimizing antihypertensive drug treatment after a stroke, little is known about recent office-based antihypertensive drug treatment patterns in the United States. We assessed national trends in antihypertensive treatment of stroke patients in office-based medical practice. Methods Datafrom the 2000-2009 National Ambulatory Medical Care Surveys were analyzed comprising outpatient visits to physicians in office-based practice by patientsaged ≥ 40 yearswith a diagnosis of stroke(weighted estimate = 46,317,269). The main outcome measure was visits with a prescription of antihypertensive medication(s). Results The proportion of total visits that included a prescription of antihypertensive medicationwas 35.6% in 2000-2002, 29.5% in 2003-2005, and 49.3% in 2006-2009 (p=0.002);50.9% were primary care physician (PCP) visits vs.26.2% neurologist-visits (<0.0001).Age-adjusted logistic regression analyses confirmed a higher prescription rate in 2006-2009 vs. 2000-2002 (1.81, 95% CI=1.10-2.96) and PCP vs. neurologists (2.82, 95% CI=1.86-4.27). Use of two or more agent classes was 31.6% in 2000-2002, 44.2% in 2003-2005, and 56.7% in 2006-2009 (p=0.014). Age-adjusted logistic regression analyses confirmed a higher prescription rate of ≥ 2 agent classesin 2006-2009 vs. 2000-2002 (2.96, 95% CI=1.40-6.24). There were no significant differences in agent class type or number between neurologists vs. PCPs. Conclusion Over the last decade, there was a significant rise in use of antihypertensive drugs and combination of agent classes for patients aged≥ 40 years seen in an ambulatory setting with a diagnosis of stroke. PCPs were more likely than neurologists to prescribe these agents.

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Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Abstract: Background and Purpose-The

Cited by 41 publications

References 26 publications

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

Twenty-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower-Extremity Arterial Thromboembolism

Statin Medication Use and Nosocomial Infection Risk in the Acute Phase of Stroke

Trends in Antihypertensive Drug Prescription Patterns among Ambulatory Stroke Patients in the United States, 2000-2009

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