American Heart Association

Monthly Archives: December 2017

The PLUMBER Study Yields an Important Piece of the Stroke Systems of Care Puzzle

Neal S. Parikh, MD 
@NealSParikhMD

Dozois A, Hampton L, Kingston CW, Lambert G, Porcelli TJ, Sorenson D, et al. PLUMBER Study (Prevalence of Large Vessel Occlusion Strokes in Mecklenburg County Emergency Response). Stroke. 2017

Optimizing access to endovascular therapy has become a public health priority. While various national guidelines seek to shape acute stroke EMS triage practices broadly, regulatory bodies have also acknowledged the need to tailor protocols to local and regional environments.

In deciding whether to triage an individual patient with suspected stroke to an endovascular center instead of a primary stroke center, EMS may consider factors such as relative travel distances, stroke severity, and the likelihood of a large vessel occlusion (LVO).

LVO screening tools have inherent imprecision, and the positive predictive value, of course, depends on the prevalence of LVO. For this reason, knowing the prevalence of LVO among acute ischemic stroke 9-1-1 dispatches is of importance. Further, at an organizational level, the accuracy and precision of LVO detection in the field has upstream implications for case load at endovascular and non-endovascular centers. The importance of these considerations varies by locale.

Adherence and Intensity of Statin Therapy

Kevin S. Attenhofer, MD

Kim J, Lee HS, Nam CM, Heo JH. Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke. Stroke. 2017

Statin medications and cholesterol management remain topics of debate over ten years after the publishing of the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial. With many questions remaining, the authors investigated the effects of statin intensity and adherence on the long-term prognoses after acute ischemic strokes in Korea.

In this paper, Kim et al. present a retrospective cohort study based on nationwide Korean population-based health insurance data. They used diagnosis codes to identify patients with ischemic stroke and then collected prescription records (type, dosage, duration, and date) of statins. In order to determine adherence, they calculated the proportion of days covered (PDC) by any statin prescription for a period of 1 year after acute ischemic stroke. Poor adherence was PDC < 40%, intermediate adherence was PDC 40-80%, and good adherence was PDC > 80%. Their primary outcome was composite of recurrent stroke, myocardial infarction (MI) and all-cause death. Again, diagnosis codes were used to obtain this information. Recurrent stroke was defined as re-hospitalization with a primary diagnosis of I60-63. MI was defined as primary diagnosis code of I21.

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