Published online before print December 8, 2005, doi: 10.1161/01.STR.0000195127.12990.43
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2006;37:44.)
© 2006 American Heart Association, Inc.
Original Contributions |
Lipid Testing and Lipid-Lowering Therapy in Hospitalized Ischemic Stroke and Transient Ischemic Attack Patients
Results From a Statewide Stroke Registry
From the Department of Epidemiology (A.J.M., M.J.R., G.L.B., S.W.), Michigan State University, East Lansing, Mich; Department of Neurology (B.S.J.), Wayne State University School of Medicine, Detroit, Mich; Borgess Health System (R.U.K.), Kalamazoo, Mich; Department of Neurology and Ophthalmology (G.L.B., S.W.), Michigan State University, East Lansing, Mich; Department of Neurology (K.M.), University of Michigan, Ann Arbor, Mich; and Michigan Department of Community Health (S.S.-R.), Lansing, Mich.
Correspondence to Mathew Reeves, PhD, Department of Epidemiology, Michigan State University, B601 West Fee Hall, East Lansing, MI 48824. E-mail reevesm{at}msu.edu
Background and Purpose— Recent recommendations call for in-hospital initiation of lipid-lowering therapy (LLT) for most ischemic stroke (IS) and transient ischemic attack (TIA) survivors; however, little is known about actual use. This study describes use of and predictors for in-hospital lipid testing and LLT using data from a statewide stroke registry.
Methods— In 2002, the registry ascertained cases from a stratified sample of 16 hospitals. This study includes only IS and TIA cases discharged alive.
Results— In 1907 study subjects, 30.2% (27.2% to 33.5%) were on LLT at admission. In 1399 subjects not on LLT at admission, 37.2% (30.2% to 44.9%) underwent lipid testing, and 12.9% (7.2% to 22.1%) received LLT at discharge. Use of testing and LLT varied widely between hospitals (P<0.001). In-hospital lipid testing was positively associated with large teaching hospitals (P=0.029), and neurologist or neurosurgeon (P=0.004); and negatively associated with increasing age (P=0.002), being female (P=0.020), a previous medical history of atrial fibrillation (P=0.002), nonambulatory status (P=0.005), and poor prognosis (P<0.001). LLT at discharge was positively associated with a previous medical history of dyslipidemia (P<0.001), lipid testing (P=0.004), and elevated low-density lipoprotein levels (P<0.001). Among subjects who were not on LLT at admission but who had Adult Treatment Panel III–based indications for use of LLT, only 31.2% (20.5% to 44.5%) received LLT at discharge.
Conclusions— Many hospitalized acute IS and TIA patients with indications for LLT are untreated at discharge. Efforts to close treatment gaps in lipid evaluation and treatment require sustained quality improvement efforts and should pay particular attention to high-risk patients.
Key Words: lipids • quality of health care • registries • stroke, acute
This article has been cited by other articles:
 |
|
 |
|
  M. J. Reeves, J. W. Gargano, Z. Luo, A. J. Mullard, B. S. Jacobs, A. Majid, and for the Paul Coverdell National Acute Stroke Regis Effect of Pretreatment With Statins on Ischemic Stroke Outcomes Stroke, June 1, 2008; 39(6): 1779 - 1785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, S. Wehner, and M. Reeves Sex Differences in Acute Stroke Care in a Statewide Stroke Registry Stroke, January 1, 2008; 39(1): 24 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, M. J. Reeves, and for the Paul Coverdell National Acute Stroke Regis Sex Differences in Stroke Recovery and Stroke-Specific Quality of Life: Results From a Statewide Stroke Registry Stroke, September 1, 2007; 38(9): 2541 - 2548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. Smith, A. R. Abdullah, H. Amirfarzan, and L. H. Schwamm Serum lipid profile on admission for ischemic stroke: Failure to meet National Cholesterol Education Program Adult Treatment Panel (NCEP-ATPIII) guidelines Neurology, February 27, 2007; 68(9): 660 - 665. [Abstract] [Full Text] [PDF]
|
|