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Frequency and determinants of lipid testing in ischemic stroke and transient ischemic attack: findings from get with
Eric E Smith1, Wenqin Pan, DaiWai Olson
1Calgary Stroke Program, University of Calgary, Alberta, Canada. eesmith@ucalgary.ca
Insights
Lipid testing for stroke patients increased significantly with quality improvement programs. Despite improvements, disparities in low-density lipoprotein (LDL) testing persist, though results often guide treatment.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Public Health
Background:
- National guidelines advocate for lipid testing in patients experiencing ischemic stroke or transient ischemic attack.
- This study investigates the prevalence and predictors of in-hospital low-density lipoprotein (LDL) testing.
Purpose of the Study:
- To assess the trends and influencing factors of LDL testing in hospitalized stroke patients.
- To identify patient and hospital characteristics associated with lipid testing adherence.
Main Methods:
- Utilized data from 981 Get With The Guideline-Stroke (GWTG-Stroke) hospitals between 2003 and 2008.
- Analyzed 479,284 consecutive ischemic stroke or transient ischemic attack admissions.
- Employed logistic regression models to identify predictors of LDL testing.
Main Results:
- The frequency of LDL measurement rose from 54.3% in 2003 to 81.9% in 2008.
- Increased participation in GWTG-Stroke was associated with higher LDL testing rates.
- Testing was less frequent in women, nonsmokers, and patients with atrial fibrillation or prior stroke/TIA.
Conclusions:
- Significant improvements in LDL measurement rates were observed within a large quality improvement initiative.
- Despite progress, disparities in LDL testing among stroke patients remain.
- LDL testing frequently identified levels that warranted adjustments in clinical management.
Background And Purpose:
National guidelines recommend lipid testing for all patients with ischemic stroke and transient ischemic attack. This study examined the frequency and predictors for in-hospital low-density lipoprotein testing using data from a nationwide stroke registry.
Methods:
Between 2003 and 2008, Get With The Guideline-Stroke (GWTG-Stroke) hospitals (n=981) contributed 479 284 consecutive ischemic stroke or transient ischemic attack admissions. Logistic regression models were used to determine patient and hospital characteristics associated with lipid testing.
Results:
Frequency of LDL measurement increased from 54.3% in 2003 to 81.9% in 2008 (P<0.001), the adjusted OR for LDL measurement was 1.23 per additional calendar year (95% CI, 1.18 to 1.29; P<0.001). The frequency of LDL measurement also increased with longer hospital program participation; the adjusted OR was 1.17 per additional year of GWTG-Stroke participation (95% CI, 1.12 to 1.23; P<0.001). LDL measurement was lower in women, nonsmokers, those with atrial fibrillation, those with a history of stroke or transient ischemic attack, and in those with transient ischemic attack (versus ischemic stroke; all P<0.001). LDL >or=100 mg/dL was seen in 52.1% of those tested, including in 35.5% of patients already prescribed lipid-lowering therapy before admission.
Conclusions:
Rates of LDL measurement in hospitalized patients with ischemic stroke and transient ischemic attack have improved dramatically in this large quality improvement program, although disparities in testing still exist. Testing frequently revealed an LDL level that could prompt a change in clinical management.
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