Baseline Prescription and One-Year Persistence of Secondary Prevention Drugs after an index Stroke in Central Ghana.
Baseline Prescription and One-Year Persistence of Secondary Prevention Drugs after an index Stroke in Central Ghana.
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DOI：
10.1016/j.ensci.2016.12.003
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Kyem G
中科院分区：
文献类型：
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作者：
Sarfo FS;Ovbiagele B;Akassi J;Kyem G
在资源有限的环境中，卒中处于快速上升的轨迹，其管理受到严重挑战，关于卒中幸存者中二级预防药物持久性的数据缺乏。为避免卒中后发生新的心血管事件，应及时制定并持续使用预防药物。我们报告了加纳中风后1年的发生率和持续使用二级预防治疗的决定因素。2011年1月至2013年12月，在加纳中部一所高等教育机构的神经病学诊所进行了一项回顾性观察研究，纳入了418名中风幸存者。从患者图表中收集人口统计学、卒中类型、危险因素概况和抗高血压、抗血小板、他汀类药物、降糖药和抗凝血药等5种二级风险预防药物类别的数据。卒中后一年内的持续被定义为在入组时继续服用神经病学诊所规定的所有二级预防药物，并排除了126例（≈30%）无法完成12个月随访的患者。数据于2015年6月关闭以供分析，以便进行至少12个月的随访。二级预防药物使用率及其强度受脑卒中类型和主要血管危险因素的影响。降压药、降脂药、抗血小板药、降糖药和抗凝血药的使用频率依次为394（94.3%）、303（72.5%）、274（65.6%）、61（14.6%）和2（0.5%）。总体而言，随访1年的92.1%的受试者（n = 292）在入组时坚持服用二级预防药物，其中降压药的药物类别特异性率为97.5%，抗血小板药物为94.8%，他汀类药物为94.1%，抗糖尿病药物为85.7%，抗凝血药物为50%。酒精滥用与非持续性显著相关，校正OR （95% CI）为3.08（1.13-8.38）。在这个资源有限的环境中，卒中幸存者中二级预防药物的持久性非常好，与资源丰富的国家相当。然而，有必要调查护理人员高流失率的原因。建议中风后立即开始使用心血管疾病预防药物。高血压、血脂异常、糖尿病在加纳中风幸存者中最常见的可改变的心血管疾病危险因素使用降压药、降脂药和抗血小板药的比例分别为94%、73%和66%。中风幸存者12个月随访损失30%。92%的中风幸存者在12个月时坚持服用心血管疾病预防药物。
There is a paucity of data on persistence of secondary prevention medications among stroke survivors in resource-limited settings where stroke is on a rapid upward trajectory and its management severely challenged. To avert new cardiovascular events after stroke, preventive medications should be promptly instituted and used continuously. We report 1-year rates and determinants of persistent utilization of secondary prevention therapies after stroke in Ghana. A retrospective observational study involving 418 stroke survivors enrolled into a Neurology clinic in a tertiary institution in central Ghana between January 2011 and December 2013. Data on demography, stroke type, risk factor profile and five secondary risk prevention medication classes namely antihypertensive, antiplatelet, statins, antidiabetic and anticoagulants were collected from patient charts. Persistence within first year after stroke was defined as continuation of all secondary preventive medications prescribed at enrollment to the Neurology clinic and it excluded 126 (≈ 30%) patients who could not complete 12 month follow up. Data was closed for analysis in June 2015 to allow for at least 12 months of follow-up. Rates of utilization of secondary preventive medications and its intensity were influenced by stroke type and prevailing vascular risk factors. In decreasing order, antihypertensive, lipid-modifying, anti-platelet, anti-diabetic medications and anti-coagulants were prescribed at frequencies (%) of 394 (94.3%), 303 (72.5%), 274 (65.6%), 61 (14.6%) and 2 (0.5%) respectively at enrollment into the Neurology clinic (n = 418). Overall, 92.1% of subjects (n = 292) under follow-up for 1 year were persistent on secondary prevention medications initiated at enrollment into the neurology clinic with medication class specific rates of 97.5% for antihypertensive, 94.8% for anti-platelets, 94.1% for statins, 85.7% for anti-diabetic and 50% for anticoagulants. Abuse of alcohol was significantly associated with non-persistence, adjusted OR (95% CI) of 3.08 (1.13–8.38). Persistence of secondary preventive medications among stroke survivors in this resource-limited setting is excellent and comparable to those in resource-replete countries. There is however the need to investigate the causes of high attrition rates from care. Prompt initiation of CVD preventive drugs is recommended after stroke. Hypertension, dyslipidemia, diabetes commonest modifiable CVD risk factors identified among Ghanaian stroke survivors. Antihypertensive, lipid-modifying, anti-platelet agents prescribed at 94%, 73% and 66% respectively. 30% Loss to follow-up among stroke survivors at month 12. 92% of stroke survivors persisted on CVD preventive drugs at month 12.