Abstract WP84: Temporal Trends in Nimodipine Use Among Aneurysmal Subarachnoid Hemorrhage Patients in The U.S.
INTRODUCTION: Delayed cerebral ischemia (DCI) is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Nimodipine is the only available treatment shown to prevent DCI and AHA guidelines have recommended its use since 1994 (Class I; Level of Evidence A). We queried the PREMIER database to investigate current utilization of nimodipine in the United States.
Methods For this analysis, we utilized the Premier database, a representative sampling of US hospitals with pharmacy data from 2006 to 2010. Patients >18 years old with an aSAH (ICD-9 code 430) primary diagnosis and survival to hospital day 2 were included. Descriptive univariate analyses were performed utilizing student’s t-test, Wilcoxon rank sum or Chi square as appropriate. Logistic regression was used to analyze nimodipine use over time.
Results Among 13,267 aSAH cases identified, 7,990 (62.2%) received at least one dose of nimodipine. See Table for patient characteristics. Nimodipine use steadily decreased from 65.4% (2006, 1st quarter) to 51.2% (2010, 4th quarter; p<0.001) during 5-year study period.
Conclusions Despite Class I recommendations, only approximately 2/3 of patients with aSAH received nimodipine from 2006 to 2010 in this US sampling. Younger age, academic institutions, and longer length of stay were associated with predictors nimodipine use. Our finding of decreased utilization of nimodipine over time is unexpected and the explanation is not readily apparent. Further research should be performed to evaluate the reasons for these practice patterns and their clinical significance.
- © 2012 by American Heart Association, Inc.