J Clin Neurol.  2013 Oct;9(4):214-222. 10.3988/jcn.2013.9.4.214.

Statin Prescription Adhered to Guidelines for Patients Hospitalized due to Acute Ischemic Stroke or Transient Ischemic Attack

Affiliations
  • 1Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 2Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. ssbrain@hallym.ac.kr
  • 3Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
  • 4Department of Neurology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 5Department of Neurology, Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 6Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 7Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND PURPOSE
Secondary stroke prevention guidelines recommend statins for the management of dyslipidemia in ischemic stroke and transient ischemic attack (TIA). This study assessed the guideline-based statin prescription (GBSP) rate in Korea and the associated physician and patient factors.
METHODS
A survey was conducted to assess Korean neurologists' knowledge of and attitude toward the current dyslipidemia management guidelines. The characteristics and discharge statin prescription for all consecutive patients with acute ischemic stroke or TIA treated by participating neurologists during the 6 months prior to the survey were abstracted. Using algorithms to determine GBSP, we assessed the rate and independent factors of GBSP.
RESULTS
Of the 174 participating neurologists, 79 (45.4%) were categorized as a higher-level knowledge group. For the 4407 patients (mean age, 66.4 years; female, 42.5%; 90.6% with ischemic stroke and 9.4% with TIA) enrolled in this study, the GBSP rate at discharge was 78.6%. The GBSP rate increased significantly with increasing physician knowledge level (test for trend, p<0.0001), and was higher among patients treated by the higher-level knowledge group than for those treated by the lower-level knowledge group (81.6% vs. 74.7%; unadjusted p<0.0001 and adjusted p=0.045). Other independent factors associated with a higher GBSP rate were hypercholesterolemia and higher low-density lipoprotein cholesterol level, while those associated with a lower GBSP rate were cardioembolism, undetermined etiology due to negative or incomplete work-up, other determined etiology, and TIA presentation.
CONCLUSIONS
More than three-quarters of acute ischemic stroke survivors and TIA patients receive a GBSP at discharge, and this proportion would be further improved by improving the knowledge of dyslipidemia management guidelines among neurologists.

Keyword

statin; guideline; adherence; ischemic stroke; transient ischemic attack; secondary stroke prevention

MeSH Terms

Cholesterol
Dyslipidemias
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Hypercholesterolemia
Ischemic Attack, Transient*
Korea
Lipoproteins
Prescriptions*
Stroke*
Survivors
Cholesterol
Lipoproteins

Figure

  • Fig. 1 GBSP rate according to physician's knowledge level. The number (n) in the parenthesis indicates the number of patients treated by physicians with each knowledge score. Error bars indicate standard errors. GBSP: guideline-based statin prescription.


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