Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke
Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke
复制标题
DOI：
10.1212/wnl.0000000000011083
复制
发表时间：
2021-01-05
期刊：
影响因子：
9.9
通讯作者：
Kilkenny, Monique F.
中科院分区：
文献类型：
--
作者：
Dalli, Lachlan L.;Kim, Joosup;Kilkenny, Monique F.
目的探讨社区卒中或短暂性脑缺血发作（TIA）后患者、急诊护理或初级护理因素是否与药物治疗的启动和终止相关。方法这是一项回顾性队列研究，使用澳大利亚卒中临床登记处（2010年4月至2014年6月）首次急性卒中/TIA成人患者的前瞻性数据，与全国范围内的药物分配和医疗保险索赔数据相关联。药物使用者是指出院后一年内配药次数>= 1次的患者。在药物使用者中评估停药情况，停药定义为出院后一年内无药物供应≥ 90天。进行多变量竞争风险回归，解释观察期间的死亡，以研究与停药时间相关的因素。结果在17，980例登记的卒中/TIA患者中，91.4%与管理数据集相关联。其中，纳入了9，817例首次卒中/TIA的成人患者（45.4%为女性，47.6%年龄≥ 75岁，11.4%为脑出血）。虽然大多数患者接受了二级预防药物（79.3%的抗高血压药物，81.8%的抗血栓药物和82.7%的降脂药物），但五分之一至三分之一的患者在出院后的第二年停止治疗（20.9%的抗高血压药物，34.1%的抗血栓药物和28.5%的降脂药物）。出院时的处方（亚风险比[SHR] 0.70; 95%置信区间[CI] 0.62-0.79）、每季度与初级保健医生联系（SHR 0.62; 95% CI 0.57-0.67）和专科医生处方（SHR 0.87; 95% CI 0.77-0.98）均与降压药停药呈负相关。结论卒中/TIA后二级预防药物的使用模式并不理想，许多幸存者在出院后1年内停止治疗。需要改善卒中/TIA患者的出院后护理，以尽量减少不必要的停药。
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.