Abstract 2532: Improving Motor Recovery after Stroke: Opportunities for FLAME Study Results
Introduction: The Fluoxetine for Motor Recovery after Acute Ischaemic Stroke Study (FLAME, published in 2011) showed that fluoxetine, when administered early to patients suffering from an acute ischemic stroke with moderate to severe hemiplegia, improved motor recovery and reduced the number of dependent patients at 90 days. We sought to estimate the number of cases who might have benefited from this intervention using the population-based Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) database.
Methods: Stroke cases for calendar year 2005 were ascertained using ICD- 9 discharge codes 430-436. The GCNK region comprises a population of 1.3 million, which is similar to the United States with regard to the proportion of African Americans and socioeconomic status. Data from the hospital record of all potential cases were abstracted by research nurses and then reviewed by study physicians for verification of cases. Based on FLAME study eligibility criteria, patients with a diagnosis of ischemic stroke between 18 and 85 years of age and with hemiparesis or hemiplegia (NIHSS ≥ 1 on both items 5a and 6a or 5b and 6b) were retrospectively considered candidates for therapy with fluoxetine. Patients were not considered candidates if they had a NIHSS > 20, a pre stroke mRS ≥ 3, severe aphasia (NIHSS ≥ 2 on item 9), or dysarthria (NIHSS ≥2 on item 10).
Results: In 2005, 2234 ischemic strokes were identified. Of these, 427 (19%) would have been candidates for therapy with fluoxetine for motor recovery. Among patients eligible for fluoxetine, 98 (23%) had a diagnosis of depression at discharge, of which 24 (5.6%) were newly diagnosed. At time of discharge, 109 (25.5%) of patients eligible for fluoxetine were prescribed some form of antidepressant, and 66 (15.5%) were prescribed a SSRI. However, only 5 (1.2%) were discharged on fluoxetine (Table). The majority of those discharged on antidepressants had this medication prescribed prior to suffering a stroke (71.6%).
Conclusions: We found that 1 in 5 (19%) of ischemic strokes met criteria for the FLAME study. This represents about 130,000 cases per year in the USA. Meeting this goal would require a significant change of practice as only 15% of eligible cases in our community were prescribed an SSRI and only 1.2% were prescribed fluoxetine upon discharge. It is still unclear how the publication of FLAME will alter SSRI prescription patterns in 2011.
- © 2012 by American Heart Association, Inc.