Persistence of secondary prevention medication and related factors for acute ischemic stroke and transient ischemic attack in China
Persistence of secondary prevention medication and related factors for acute ischemic stroke and transient ischemic attack in China
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DOI：
10.1080/01616412.2017.1312792
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Wang, Chen
中科院分区：
文献类型：
--
作者：
Jiang, Yue;Yang, Xiaomeng;Wang, Chen
目的：我们最近测量了出院后二级预防药物的纵向使用情况以及影响中国急性缺血性卒中（AIS）和短暂性脑缺血发作（TIA）患者持续性的因素。方法：对2012年6月至2013年1月入组中国国家卒中注册中心II的AIS和TIA患者进行调查，以确定持续性。药物包括抗血小板治疗、华法林、抗高血压治疗、他汀类药物和糖尿病药物。我们确定了出院后三个月的持续性。持续性定义为出院时继续使用处方的所有二级预防药物。出院后3个月的药物持续性的相关因素进行了检查，使用多变量logistic regression.Results：AIS和TIA的21,592例患者中，18,344（91.2%）符合分析条件。出院后3个月，46.2%的受试者继续服用出院时处方的所有二级预防药物。3个月药物持续性的独立预测因素包括年龄较小、无糖尿病或房颤病史、家庭收入较高、卒中严重程度较轻、缺血性卒中的指数脑血管事件、在有卒中单元和神经科床位较多的医院接受治疗。超过一半的AIS和TIA患者报告在出院后3个月内停用一种或多种二级预防药物。确定了与药物持续性相关的几个因素。在这里，我们提出了可以实施的战略，以提高二级预防的质量。
Objective: We recently measured the longitudinal use of secondary prevention medication following hospital discharge and the factors influencing persistence in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) in China.Methods: Patients with AIS and TIA who were enrolled in the China National Stroke Registry II from June 2012 to January 2013 were surveyed to determine persistence. The medications included antiplatelet therapies, warfarin, antihypertensive therapies, statins, and diabetes medications. We determined persistence for a three-month period following discharge. Persistence was defined as the continuation of all secondary preventive medications prescribed upon hospital discharge. The factors associated with medication persistence 3 months after discharge were examined using a multivariable logistic regression.Results: Of the 21,592 patients with AIS and TIA, 18,344 (91.2%) were eligible for analysis. After 3 months post-discharge, 46.2% of the subjects continued to take all secondary prevention medications prescribed at discharge. Independent predictors of three-month medication persistence included younger age, absence of a history of diabetes or atrial fibrillation, higher family income, less severe stroke, index cerebrovascular event of ischemic stroke, and being treated in a hospital with a stroke unit and more beds in the neurology department.Conclusions: More than half of patients with AIS and TIA reported discontinuing one or more secondary prevention medications within 3 months of hospital discharge. Several factors associated with medication persistence were identified. Here, we propose strategies that could be implemented to improve the quality of secondary prevention.