Clinical Effectiveness of Statin Therapy after Ischemic Stroke: Primary Results from the Statin Therapeutic Area of the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study
Background—In patients with ischemic stroke, data on real-world effectiveness of statin therapy for clinical and patient-centered outcomes is needed to better inform shared decision-making.
Methods and Results—PROSPER is a PCORI-funded research program designed with stroke survivors to evaluate effectiveness of post-stroke therapies. We linked data on patients ≥65 years of age enrolled in the GWTG®-Stroke Registry to Medicare claims. Two-year post-discharge outcomes of those discharged on a statin versus not were adjusted using inverse probability weighting. Our co-primary outcomes were: 1) major adverse cardiovascular events (MACE); and 2) home-time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007-2011, 77,468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard (hazard ratio; 95% confidence interval) of MACE (0.91; 0.87, 0.94), 28 more home-time days following discharge (p<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (0.94; 0.72, 1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had similar outcomes compared with moderate-intensity recipients.
Conclusions—In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of MACE and nearly a month more home-time during the 2-year period post-hospitalization.
- Received February 23, 2015.
- Revision received July 13, 2015.
- Accepted July 27, 2015.