Evidence map›Paper›PMID 27473035›Full record

ArticleJournal of the American Heart Association2016

Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention.

Alexander C Flint, Carol Conell, Jeff G Klingman, Vivek A Rao, Sheila L Chan, Hooman Kamel, Sean P Cullen, Bonnie S Faigeles, Steve Sidney, S Claiborne Johnston

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.2field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 11 citations in OpenAlex.

  1. Trial
  2. Review
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Alexander C FlintDepartment of Neuroscience, Kaiser Permanente, Redwood City, CA Division of Research, Kaiser Permanente Northern California, Oakland, CA alexander.c.flint@kp.org.
Carol ConellDivision of Research, Kaiser Permanente Northern California, Oakland, CA.
Jeff G KlingmanDepartment of Neurology, Kaiser Permanente, Walnut Creek, CA.
Vivek A RaoDepartment of Neuroscience, Kaiser Permanente, Redwood City, CA.
Sheila L ChanDepartment of Neuroscience, Kaiser Permanente, Redwood City, CA.
Hooman KamelDepartment of Neurology, Weill Cornell Medical Center, New York, NY.
Sean P CullenDepartment of Neuroscience, Kaiser Permanente, Redwood City, CA.
Bonnie S FaigelesDepartment of Neuroscience, Kaiser Permanente, Redwood City, CA.
Steve SidneyDivision of Research, Kaiser Permanente Northern California, Oakland, CA.
S Claiborne JohnstonDell Medical School, University of Texas, Austin, TX.
Kaiser Permanente Redwood City Medical Center · USKaiser Permanente · USCornell University · USKaiser Permanente Walnut Creek Medical Center · USThe University of Texas at Austin · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStatin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization. METHODS AND

resultsThis is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time-series modeling. The EMR intervention increased both overall in-hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [Pdiff]=0.02, P=0.016) and discharge to home or rehabilitation facility (Pdiff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (Pdiff=0.17, P=0.033) and rate of discharge to home or rehabilitation (Pdiff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in-hospital (Pdiff=-0.14, P=0.026).

conclusionsA simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.

Indexed as

AgedBrain IschemiaDrug Administration ScheduleElectronic Health RecordsFemaleHospitalizationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleNootropic AgentsRecurrenceRetrospective StudiesStrokeTreatment OutcomeHydroxymethylglutaryl-CoA Reductase InhibitorsNootropic Agentselectronic medical record interventionischemic strokeorder setsoutcomestatin intervention

Identifiers

PMID27473035
PMCPMC5015276
OpenAlexW2484204832

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.