Patterns of use and discontinuation of secondary prevention medications after stroke

Lachlan Dalli, Joosup Kim, Amanda G. Thrift, Nadine E. Andrew, Frank 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

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Objective: To investigate whether certain patient, acute-care, or primary-care factors are associated with medication initiation and discontinuation in the community post-stroke or TIA.
Methods: 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 post-discharge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year post-discharge. 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 post-discharge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR]: 0.70; 95% 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 one-year post-discharge. Improving post-discharge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
Original languageEnglish
JournalNeurology
DOIs
Publication statusE-pub ahead of print - 22 Oct 2020

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