Statins still not prescribed at Discharge among 1 in 4 Stroke Patients inspite of large awareness campaign.
Current guidelines call for in-hospital initiation of statin therapy for patients with stroke or transient ischemic attack (TIA) of atherosclerotic origin and continuing statin therapy in stroke patients at the time of discharge.
However, an observational study conducted in Ratnagiri which was supported by The Niramal Clinics finds that 1 in 4 of these patients is still not prescribed statins at hospital discharge and that reports from clinical trials documenting the effectiveness of statins in secondary stroke prevention apparently had no lasting impact on clinical practice. This is inspite of the fact that the cost of statins have come down significantly after many Indian companies have started maufracturing the medicine.
Incidentally I came to read a good article related to the issue in which a very large cohort was studied. "Approximately 1 in 10 stroke patients experience another stroke within a week," said lead study author Bruce Ovbiagele, MD, MsC, director of the UCLA Stroke Prevention Program at the
A simple observation and recording of prescriptions were done in indoor patients and OPD patients following up with another doctor to assess trends in discharge statin treatment and to see whether such treatment changed in response to dissemination of results from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. They also analyzed factors that might predict whether patients would get statins or not. The study pattern was not revealed to any colleague doctor to avoid bias factor. The study lasted for a period of about 9 months and involved 500 entries.
During the study period, discharge statin prescription rates climbed "steadily but modestly," they write, from 75.7% to 84.8%. Young doctors were found to more often omit a statin prescription. General practitioners were more consistent with prescriptions. Combination medications were less used though they had the benefit of cost control and patient compliance. Patients who presented with TIA rather than ischemic stroke, who had known coronary artery disease, or who had known peripheral vascular disease were also less likely to receive discharge statin prescriptions. An estimated 28% patient were not prescribed statins though it was indicated.
"While statin use after stroke improved over time, 28% of eligible stroke patients still leave the hospital without statin treatment, which unnecessarily exposes them to the risk of another stroke. Colleague doctors should take note of this and update themselves about these newer protocols. It may be worth educating the population about these medicines, as has been done in many advanced countries, since they have the potential to reduce the economic and social burden of paralysis " Dr. Pratyush Chaudhuri said.
This study was funded by the Nirmal clinics, Ratnagiri.
