Ji Ruijun, Liu Gaifen, Shen Haipeng, Wang Yilong, Li Hao, Peterson Eric, Wang Yongjun
Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China.
Neurol Res. 2013 Jan;35(1):29-36. doi: 10.1179/1743132812Y.0000000107.
Although proven stroke secondary prevention medications are available, persistent use is required to be effective. The present study aimed to investigate the degree of secondary prevention medications persistence after acute ischemic stroke (AIS) or transient ischemic attack (TIA), factors influencing persistence and its association with stroke outcomes.
We examined patients with AIS or TIA enrolled in China National Stroke Registry (CNSR) between 2007 and 2008. Three-month persistence was defined as medication continuation between hospital discharge and 3-month postdischarge. Recurrent stroke and modified Rankin scale (mRS)≤2 at 3-month postdischarge were used as stroke outcomes. Logistic regression was used to adjust for confounders.
Totally, 9998 patients were analyzed. At 3 months, 63·6% of patients continued taking all secondary prevention medications prescribed at hospital discharge. Younger age (P = 0·05), male gender (P = 0·03), present history of hypertension (P<0·001), absent history of atrial fibrillation (P<0·001), pre-stroke independence (P = 0·05), index cerebrovascular event of AIS (P = 0·005), being treated in an academic hospital (P = 0·003), longer hospital stay (P<0·001), and fewer number of class of baseline secondary prevention medications (P<0·001) were identified as determinants for 3-month persistence. 3-month persistence of secondary prevention medications were significantly associated with less recurrent stroke (adjusted OR = 0·78, 95% CI = 0·67-0·91, P = 0·002) and better functional outcome (mRS≤2) (adjusted OR = 1·17, 95% CI = 1·04-1·32, P = 0·009) at 3-month postdischarge.
Almost one-third of patients of AIS/TIA had stopped one or more secondary prevention medications by 3-month postdischarge. Further studies on identifying potential barriers and means to improve persistent use of secondary prevention interventions are needed.
尽管有经证实有效的中风二级预防药物，但需持续使用才能起效。本研究旨在调查急性缺血性中风（AIS）或短暂性脑缺血发作（TIA）后二级预防药物的持续使用程度、影响持续使用的因素及其与中风预后的关联。
我们研究了2007年至2008年在中国国家中风登记系统（CNSR）登记的AIS或TIA患者。三个月持续用药定义为出院后至出院后三个月期间持续用药。出院后三个月的复发性中风和改良Rankin量表（mRS）≤2作为中风预后指标。采用逻辑回归分析来调整混杂因素。
共分析了9998例患者。三个月时，63.6%的患者继续服用出院时开具的所有二级预防药物。年龄较小（P = 0.05）、男性（P = 0.03）、有高血压病史（P<0.001）、无房颤病史（P<0.001）、中风前生活能自理（P = 0.05）、首次脑血管事件为AIS（P = 0.005）、在教学医院接受治疗（P = 0.003）、住院时间较长（P<0.001）以及基线二级预防药物种类较少（P<0.001）被确定为三个月持续用药的决定因素。出院后三个月二级预防药物的持续使用与复发性中风较少（校正比值比 = 0.78，95%可信区间 = 0.67 - 0.91，P = 0.002）以及更好的功能预后（mRS≤2）（校正比值比 = 1.17，95%可信区间 = 1.04 - 1.32，P = 0.009）显著相关。
几乎三分之一的AIS/TIA患者在出院后三个月时停用了一种或多种二级预防药物。需要进一步研究以确定潜在障碍和提高二级预防干预措施持续使用的方法。
