Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke. (5th January 2021)

• Record Type: Journal Article
• Authors: Dalli, Lachlan L.; Kim, Joosup; Thrift, Amanda G.; Andrew, Nadine E.; Sanfilippo, Frank M.; Lopez, Derrick; Grimley, Rohan; Lannin, Natasha A.; Wong, Lillian; Lindley, Richard I.; Campbell, Bruce C.V.; Anderson, Craig S.; Cadilhac, Dominique A.; Kilkenny, Monique F.
• Is Part Of: Neurology. Volume 96:Number 1(2021)
• Publication Date: 2021-01-05
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000011083
• Languages: English
• ISSNs: 0028-3878

Abstract

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.