Lachlan L Dalli1, Joosup Kim1, Amanda G Thrift1, Nadine E Andrew1, Frank M Sanfilippo1, Derrick Lopez1, Rohan Grimley1, Natasha A Lannin1, Lillian Wong1, Richard I Lindley1, Bruce C V Campbell1, Craig S Anderson1, Dominique A Cadilhac1, Monique F Kilkenny2. 1. From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China. 2. From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China. monique.kilkenny@monash.edu.
Abstract
OBJECTIVE: To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. METHODS: This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. RESULTS: Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62-0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57-0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77-0.98) were all inversely associated with antihypertensive discontinuation. CONCLUSIONS: Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
OBJECTIVE: To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. METHODS: This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. RESULTS: Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62-0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57-0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77-0.98) were all inversely associated with antihypertensive discontinuation. CONCLUSIONS: Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
Authors: Christian Boehme; Lena Domig; Silvia Komarek; Thomas Toell; Lukas Mayer; Benjamin Dejakum; Stefan Krebs; Raimund Pechlaner; Alexandra Bernegger; Christoph Mueller; Gerhard Rumpold; Andrea Griesmacher; Marion Vigl; Gudrun Schoenherr; Christoph Schmidauer; Julia Ferrari; Wilfried Lang; Michael Knoflach; Stefan Kiechl Journal: BMC Cardiovasc Disord Date: 2022-08-01 Impact factor: 2.174