Inpatient statin use predicts improved ischemic stroke discharge disposition
Flint AC et al. – Statin use is strongly associated with improved discharge disposition after ischemic stroke.Methods
- The authors 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.
- They also analyzed treatment patterns by hospital to control for the possibility of confounding at the individual patient level.
- 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).