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Abstract
Objective: To determine whether statin use is associated with improved discharge disposition after ischemic stroke.
Methods: We used generalized ordinal logistic regression to analyze discharge disposition among 12,689 patients with ischemic stroke over a 7-year period at 17 hospitals in an integrated care delivery system. We also analyzed treatment patterns by hospital to control for the possibility of confounding at the individual patient level.
Results: Statin users before and during stroke hospitalization were more likely to have a good discharge outcome (odds ratio [OR] for discharge to home = 1.38, 95% confidence interval [CI] 1.25–1.52, p < 0.001; OR for discharge to home or institution = 2.08, 95% CI 1.72–2.51, p < 0.001). Patients who underwent statin withdrawal were less likely to have a good discharge outcome (OR for discharge to home = 0.77, 95% CI 0.63–0.94, p = 0.012; OR for discharge to home or institution = 0.43, 95% CI 0.33–0.55, p < 0.001). In grouped-treatment analysis, an instrumental variable method using treatment patterns by hospital, higher probability of inpatient statin use predicted a higher likelihood of discharge to home (OR = 2.56, 95% CI 1.71–3.85, p < 0.001). In last prior treatment analysis, a novel instrumental variable method, patients with a higher probability of statin use were more likely to have a good discharge outcome (OR for each better level of ordinal discharge outcome = 1.19, 95% CI 1.09–1.30, p = 0.001).
Conclusions: Statin use is strongly associated with improved discharge disposition after ischemic stroke.
GLOSSARY
- CI=
- confidence interval;
- FIM=
- Functional Independence Measure;
- ICD-9=
- International Classification of Diseases, 9th revision, Clinical Modification;
- KPNC=
- Kaiser Permanente Northern California;
- MI=
- myocardial infarction;
- OR=
- odds ratio
Footnotes
Study funding: Supported by the Centers for Disease Control and Prevention and the Kaiser Permanente Community Benefits Research Fund.
Supplemental data at www.neurology.org
- Received November 18, 2011.
- Accepted January 23, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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- Statin user and discharge disposition after ischemic stroke
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