Abstract 9: Clinical Effectiveness of Statin Therapy after Ischemic Stroke: Primary Results from the PROSPER Study
Background: Evidence for statin use comes primarily from select clinical trial populations that are often younger without comorbidities. Stroke patients and their caregivers are in need of real-world effectiveness data to better inform decision-making on statin use after stroke.
Methods: PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate the effectiveness of therapies post-stroke. We linked data from Get With The Guidelines-Stroke patients >65 years of age to Medicare claims to capture post-discharge outcomes. Primary outcomes prioritized by patients were: 1) Home time (days alive and out of acute or post-acute care) and 2) Major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, all-cause readmission, CV readmission, and hemorrhagic stroke. We used negative binomial and Cox models to evaluate discharge statins and outcomes with inverse probability weighting (IPW) to adjust for baseline differences by treatment group.
Results: Of 77,468 statin-naïve ischemic stroke patients hospitalized from 2007-2011, n=54,991 (71%) were discharged on statin therapy. Compared with those not receiving a statin, patients receiving a statin were younger and more likely to be smokers. Unadjusted rates of MACE, mortality and CV readmission within 2 years were lower for statin patients compared with those not receiving a statin. After IPW adjustment, statin therapy was associated with 28 more days of home time in the 2-year post-discharge period (P <.001), 9% lower hazard of MACE (P <.001), 16% lower hazard of mortality (P <.001), and 7% lower hazard of readmission (P <.001). Statin use was not associated with increased risk of hemorrhagic stroke (P=0.56).
Conclusions: In a real-world population of older statin-naïve ischemic stroke patients, discharge statin therapy was associated with more days spent at home during the 2-year period after hospitalization and lower risk of both MACE and all-cause mortality.
Author Disclosures: E.C. O'Brien: None. M.A. Greiner: None. Y. Xian: None. G.C. Fonarow: Employment; Modest; Employee of the University of California, which holds a patent on retriever devices for stroke. Research Grant; Significant; NIH. Other; Modest; Member of the Get With The Guidelines (GWTG) steering committee. D.M. Olson: None. L.H. Schwamm: Research Grant; Significant; PI for NINDS study for which Genentech provides free alteplase and supplemental per-patient payments to participating sites. Consultant/Advisory Board; Modest; Massachusetts Department of Public Health, Lundbeck, Penumbra. Other; Modest; Chair of AHA/ASA GWTG Stroke Clinical Work Group. D.L. Bhatt: Research Grant; Modest; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company. E.E. Smith: None. L. Maisch: None. D. Hannah: None. B. Lindholm: None. E.D. Peterson: Research Grant; Modest; Lilly, Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and Merck-Schering Plough partnership. Other; Modest; Principal investigator of the data analytic center for the AHA/American Stroke Association’s (ASA) GWTG. M.J. Pencina: None. A.F. Hernandez: Research Grant; Modest; Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Novartis, Portola Pharmaceuticals. Honoraria; Modest; Amgen, GlaxoSmithKline, Janssen and Novartis.
- © 2015 by American Heart Association, Inc.