Nadine E Andrew1, Joosup Kim1, Amanda G Thrift1, Monique F Kilkenny1, Natasha A Lannin1, Craig S Anderson1, Geoffrey A Donnan1, Kelvin Hill1, Sandy Middleton1, Christopher Levi1, Steven Faux1, Rohan Grimley1, Nisal Gange1, Richard Geraghty1, Sharan Ermel1, Dominique A Cadilhac2. 1. From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia. 2. From Stroke & Ageing Research (N.E.A., J.K., A.G.T., M.F.K., R.G., D.A.C.), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; Department of Medicine (N.E.A), Peninsula Clinical School, Central Clinical School, Monash University, Frankston; Florey Institute of Neuroscience and Mental Health (J.K., M.F.K., G.A.D., D.A.C.), University of Melbourne, Heidelberg; School of Allied Health (Occupational Therapy) (N.A.L.), La Trobe University, Bundoora; Occupational Therapy Department (N.A.L.), Alfred Health, Melbourne; Faculty of Medicine (C.S.A.), The University of New South Wales, Sydney; Stroke Foundation (K.H.), Melbourne; Nursing Research Institute (S.M.), St Vincent's Health Australia, Sydney and Australian Catholic University, Sydney; University of New South Wales and the Partnership for Health Education, Research and Enterprise (SPHERE) (C.L.), Sydney; Faculty of Medicine (S.F.), The University of New South Wales, Sydney and St Vincent's Health Australia, Sydney; Statewide Stroke Clinical Network (R.G.), Queensland Health, Brisbane; Sunshine Coast Clinical School (R.G), The University of Queensland, Birtinya; Toowoomba Hospital (N.G.), Toowoomba; Redcliffe Hospital (R.G.), Brisbane; and Bendigo Health (S.E.), Bendigo, Australia. dominique.cadilhac@monash.edu.
Abstract
OBJECTIVE: To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA. METHODS: This was a large cohort study using routinely collected prospective data from the Australian Stroke Clinical Registry. Patients registered between 2009 and 2013 who were discharged to the community or rehabilitation were included. Cases were linked to the National Death Index to determine the date and cause of death. Propensity score matching with stratification was utilized to compare between similar subgroups of patients. Multivariable competing risks regression, with noncardiovascular death as a competing risk, was conducted to investigate the association between the prescription of antihypertensive medications and cardiovascular death at 180 days after admission. RESULTS: Among 12,198 patients from 40 hospitals, 70% were prescribed antihypertensive medications. Patients who were older, were treated in a stroke unit, and had better socioeconomic position were more often discharged from hospital with an antihypertensive medication. Including only patients within propensity score quintiles with acceptable levels of balance in covariates between groups (n = 8,786), prescription of antihypertensive medications was associated with a 23% greater reduction in the subhazard of cardiovascular death compared to those who were not prescribed these agents (subhazard ratio 0.77; 95% confidence interval 0.61 to 0.97). CONCLUSIONS: People who are prescribed antihypertensive medications at discharge from hospital after a stroke or TIA demonstrate better cardiovascular and all-cause survival outcomes than those not prescribed these agents.
OBJECTIVE: To investigate the risk of death from cardiovascular disease between patients who were and were not prescribed antihypertensive medication following stroke or TIA. METHODS: This was a large cohort study using routinely collected prospective data from the Australian Stroke Clinical Registry. Patients registered between 2009 and 2013 who were discharged to the community or rehabilitation were included. Cases were linked to the National Death Index to determine the date and cause of death. Propensity score matching with stratification was utilized to compare between similar subgroups of patients. Multivariable competing risks regression, with noncardiovascular death as a competing risk, was conducted to investigate the association between the prescription of antihypertensive medications and cardiovascular death at 180 days after admission. RESULTS: Among 12,198 patients from 40 hospitals, 70% were prescribed antihypertensive medications. Patients who were older, were treated in a stroke unit, and had better socioeconomic position were more often discharged from hospital with an antihypertensive medication. Including only patients within propensity score quintiles with acceptable levels of balance in covariates between groups (n = 8,786), prescription of antihypertensive medications was associated with a 23% greater reduction in the subhazard of cardiovascular death compared to those who were not prescribed these agents (subhazard ratio 0.77; 95% confidence interval 0.61 to 0.97). CONCLUSIONS:People who are prescribed antihypertensive medications at discharge from hospital after a stroke or TIA demonstrate better cardiovascular and all-cause survival outcomes than those not prescribed these agents.
Authors: N E Andrew; J Kim; D A Cadilhac; V Sundararajan; A G Thrift; L Churilov; N A Lannin; M Nelson; V Srikanth; M F Kilkenny Journal: Int J Popul Data Sci Date: 2019-08-05