Abstract Details

Title Prescription Smoking-Cessation Medication Pharmacy Claims After Stroke and Transient Ischemic Attack

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 090

Objective To examine the use of prescription smoking-cessation medications after stroke and transient ischemic attack (TIA).

Background Smoking cessation is an important part of secondary prevention after stroke and TIA. Data regarding use of smoking-cessation interventions after stroke/TIA are sparse.

Design/Methods We performed a retrospective cohort study using data from the INSIGHT Clinical Research Network, which includes clinician-entered electronic health record data merged with Medicare claims data for patients receiving care across 5 New York City institutions. We included Medicare beneficiaries with prescription drug coverage (Part D) who were hospitalized with ischemic stroke/TIA and were active smokers at that time. Patients with in-hospital mortality or discharge to long-term care facilities were excluded. The primary outcome was a claim for a prescription smoking-cessation medication (varenicline or bupropion) after hospital discharge. Nicotine replacement therapy was not included because it can be obtained without prescription. We evaluated claims for any statin medication as a comparator. We used time-to-event analysis to estimate 6- and 12-month cumulative rates of prescription drug claims.

Results Of 34,591 patients with ischemic stroke or TIA, 3,153 (9.1%) were active smokers. Among these active smokers, cumulative rates of any claim for a prescription smoking-cessation medication were 3.1% (95% CI, 2.5-3.9) at 6 months and 4.7% (95% CI, 3.9-5.6) at 12 months. In contrast, cumulative claims rates for statins were 41.4% (95% CI, 39.4-43.5) at 6 months and 48.2% (95% CI, 46.1-50.3) at 12 months. In a sensitivity analysis of patients with ongoing preventive care (> 1 statin medication claim), cumulative claims rates for any smoking-cessation medication were 3.8% (95% CI, 2.9-5.0) at 6 months and 5.7% (95% CI, 4.6-7.2) at 12 months.

Conclusions Prescription smoking-cessation medications are rarely used by smokers with stroke/TIA. These data may inform efforts to optimize secondary prevention after stroke/TIA.

Authors/Disclosures
Neal S. Parikh, MD (Alnylam Pharmaceuticals) PRESENTER	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has or had stock in Alnylam Pharmaceuticals.
	No disclosure on file
	No disclosure on file
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.

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