Department of Public Health and Family Medicine, ECU Brody School of Medicine, Greenville, North Carolina, USA.
Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
J Am Geriatr Soc. 2023 Aug;71(8):2476-2484. doi: 10.1111/jgs.18318. Epub 2023 Mar 16.
Published guidelines recommend high-intensity statins following an ischemic stroke or transient ischemic attack (TIA). The authors examined the potential for disparate patterns of statin prescribing in a cluster randomized trial of transitional care following acute stroke or TIA.
Medications taken before hospitalization and statins prescribed at discharge among stroke and TIA patients at 27 participating hospitals were examined. Any statin and intensive statin prescribed at discharge were compared by age (<65, 65-75, >75 years), racial category (White vs. Black), sex (male vs. female), and rurality (urban vs. non-urban) using logistic mixed models.
Among 3211 patients (mean age 67 years; 47% female; 29% Black), 90% and 55%, respectively, were prescribed any statin or intensive statin therapy at discharge. White (vs. Black) patients (0.71, 0.51-0.98) less commonly received any statin prescription, while stroke (vs. TIA) patients (1.90, 1.38-2.62) and those residing in urban areas (1.66, 1.07-2.55) more commonly received any statin prescription. Among those prescribed a statin, only 42% of White and 51% of Black patients >75 years. were prescribed an intensive statin; the OR for intensive statin prescribing was 0.44 for patients >75 years and was similar in a subgroup not on a statin previously.
CONCLUSION/RELEVANCE: Following stroke or TIA, statin prescribing remains lower in White patients, in those with TIA, and in those in non-urban areas. Intensive statin prescribing remains limited, particularly in patients >75 years. These data may inform efforts to improve guideline concordant prescribing for post-stroke patients.
已发表的指南建议缺血性卒中和短暂性脑缺血发作（TIA）后使用高强度他汀类药物。作者在一项急性卒中和 TIA 后过渡性护理的集群随机试验中，研究了他汀类药物处方模式存在差异的可能性。
检查了 27 家参与医院的卒中/TIA 患者住院前服用的药物和出院时开具的他汀类药物。使用逻辑混合模型，根据年龄（<65 岁、65-75 岁、>75 岁）、种族类别（白种人 vs. 黑人）、性别（男 vs. 女）和农村/城市地区（农村 vs. 城市）比较出院时开具的任何他汀类药物和强化他汀类药物。
在 3211 例患者（平均年龄 67 岁；47%为女性；29%为黑人）中，分别有 90%和 55%的患者出院时开具了任何他汀类药物或强化他汀类药物治疗。白种人（vs. 黑人）（0.71，0.51-0.98）开具任何他汀类药物处方的可能性较小，而卒中（vs. TIA）患者（1.90，1.38-2.62）和居住在城市地区（1.66，1.07-2.55）的患者开具任何他汀类药物处方的可能性较大。在开具他汀类药物的患者中，只有 42%的>75 岁的白人和 51%的>75 岁的黑人患者开具了强化他汀类药物；>75 岁患者开具强化他汀类药物的 OR 为 0.44，在先前未服用他汀类药物的亚组中，这一比值相似。
结论/相关性：卒中和 TIA 后，白种人、TIA 患者和非城市地区的他汀类药物处方仍然较少。强化他汀类药物的使用仍然有限，特别是在>75 岁的患者中。这些数据可能为改善卒中后患者的指南一致处方提供信息。
