Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke

Lachlan L Dalli; Joosup Kim; Amanda G Thrift; Nadine E Andrew; Frank M Sanfilippo; Derrick Lopez; Rohan Grimley; Natasha A Lannin; Lillian Wong; Richard I Lindley; Bruce C V Campbell; Craig S Anderson; Dominique A Cadilhac; Monique F Kilkenny; AuSCR Consortium

doi:10.1212/WNL.0000000000011083

Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke

Neurology. 2021 Jan 5;96(1):e30-e41. doi: 10.1212/WNL.0000000000011083. Epub 2020 Oct 22.

Authors

Collaborators

AuSCR Consortium:
Geoffrey Donnan, Julie Bernhardt, Paul Bew, Christopher Bladin, Greg Cadigan, Helen Castley, Erin Lalor, Andrew Lee, Mark Mackay, Sandra Martyn, John McNeil, Sandy Middleton, Michael Pollack, Mark Simcocks, Frances Simmonds, Helen Dewey, Steven Faux, Kelvin Hill, Christopher Levi, Christopher Price, Pradeep Bambery, Tim Bates, Carolyn Beltrame, David Blacker, Ernie Butler, Sean Butler, Chris Charnley, Douglas Crompton, Vanessa Crosby, Carolyn De Wytt, David Douglas, Martin Dunlop, Paula Easton, Sharan Ermel, Nisal Gange, Richard Geraghty, Melissa Gill, Graham Hall, Peter Hand, Geoffrey Herkes, Karen Hines, Francis Hishon, James Hughes, Joel Iedema, Martin Jude, Thomas Kraemer, Paul Laird, Johanna Madden, Graham Mahaffey, Suzana Milosevic, Peter O’Brien, Michaela Plante, Juan Rois-Gnecco, Stephen Read, Kristen Rowe, Fiona Ryan, Arman Sabet, Noel Saines, Eva Salud, Amanda Siller, Christopher Staples, Amanda Styles, Richard White, Andrew Wong, Robin Armstrong, Leonid Churilov, Alison Dias, Adele Gibbs, Brenda Grabsch, Francis Kung, Joyce Lim, Karen Moss, Kate Paice, Enna Salama, Sabrina Small, Renee Stojanovic, Steven Street, Emma Tod, Kasey Wallis

Affiliations

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.

PMID: 33093227
DOI: 10.1212/WNL.0000000000011083

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Australia
Chemoprevention / methods
Chemoprevention / statistics & numerical data
Cohort Studies
Female
Humans
Male
Medication Adherence / statistics & numerical data*
Retrospective Studies
Secondary Prevention / methods*
Secondary Prevention / statistics & numerical data*
Stroke / prevention & control*