Ischemic stroke patients with LDL greater than or equal to 100 mg/dL, or LDL not measured, or who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge.

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An elevated serum lipid level has been a well-documented risk factor for coronary artery disease (CAD) and reflects an organ-specific manifestation of atherosclerosis which is a disease process that can affect the heart and the major and minor branches of the arterial tree. The reduction of LDL cholesterol, through lifestyle modification and drug therapy when appropriate, is recommended for the prevention of myocardial infarction and other major vascular events for patients with CAD (or coronary risk equivalent conditions) according to the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III) Guidelines. Recently, there has been an increased focus on the detection of patients with these risk factors when they present with other manifestations of atherosclerosis, and assuring that these patients are treated with lipid lowering medication if they meet NCEP ATPIII guidelines. While symptomatic carotid artery disease is one of the recognized coronary disease risk equivalents that qualify patients for treatment under ATPIII, there was little data until recently about the role of lipid lowering to prevent recurrent stroke or major vascular events in patients who presented with atherosclerotic stroke but did not otherwise qualify for treatment under ATPIII. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study examined the effects of statins to lower LDL cholesterol in patients with stroke or TIA of atherosclerotic origin who had no other reason for taking lipid lowering therapy (i.e., they were without prior CAD or risk equivalent conditions), and had a fasting LDL greater than or equal to 100 mg/dL. The trial convincingly demonstrated that intensive lipid lowering therapy using statin medication was associated with a dramatic reduction in the rate of recurrent ischemic stroke and major coronary events. The treatment was well tolerated and cost effective. As a result, intensive lipid lowering therapy through use of a statin medication is now recommended for all patients with stroke or TIA of atherosclerotic origin who have an LDL greater than or equal to 100 mg/dL (or with LDL less than 100 mg/dL due to being on lipid lowering therapy prior to admission).

Based on these guidelines, all patients with ischemic stroke or TIA should have lipid profile measurement performed within 48 hours of admission unless results are available from within the past 30 days. A large body of evidence suggests that non-fasting lipid levels drawn in the first 48 hours after a major vascular event are reliable predictors of baseline lipid profiles, but after that time they may become unreliable. It is recommended that all patients with ischemic stroke or TIA with coronary heart disease or symptomatic atherosclerotic disease who have an LDL greater than or equal to 100 mg/dL (or with LDL less than 100 mg/dL due to being on lipid lowering therapy prior to admission) should be treated with a statin. The target goal for cholesterol lowering is an LDL-c level of less than 100 mg/dL. An LDL-c less than 70 mg/dL is recommended for very high-risk persons with multiple risk factors. For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated in those who have an LDL greater than or equal to 100 mg/dL (or with LDL less than 100 mg/dL due to being on lipid lowering therapy prior to admission).

For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated in those who have an LDL greater than or equal to 100 mg/dL (or with LDL less than 100 mg/dL due to being on lipid lowering therapy prior to admission).

An increase in rate

Adams, R. J., G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, et al. "Update to the Aha/Asa Recommendations for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack." [In eng]. Stroke 39, no. 5 (May 2008): 1647-52.

Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. "High-Dose Atorvastatin after Stroke or Transient Ischemic Attack." [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59

Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. "Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases." [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8.

Furie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76.

National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults."Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report." [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.

Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. "Statins for Acute Ischemic Stroke." [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.

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The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

Lipid-lowering medications are intended as active home meds that the patient may or may not continue to take during hospitalization.

The “Non-elective Inpatient Encounter” value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the “Inpatient encounter” value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions, including patients admitted for observation.

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Patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days.

Patients with a principal diagnosis of ischemic stroke and an LDL greater than or equal to 100 mg/dL, OR LDL not measured, OR who were on a lipid-lowering medication prior to hospital arrival.

Patients with comfort measures documented 
Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.
Patients discharged to another hospital
Patients who left against medical advice
Patients who expired
Patients discharged to home for hospice care
Patients discharged to a health care facility for hospice care

Patients prescribed statin medication at hospital discharge.

Not Applicable

Patients with a reason for not prescribing statin medication at discharge.

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.