Muñoz-Venturelli Paula, Sacks Claudio, Madrid Eva, Lavados Pablo M
Vascular Neurology Program Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
Neurology Program, Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
J Stroke Cerebrovasc Dis. 2014 Mar;23(3):490-5. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.013. Epub 2013 May 13.
Clinical guidelines for the secondary prevention of ischemic stroke have been developed, but their publication is insufficient to make them effective. Our aim was to investigate adherence to Chilean guidelines, its associated variables, and to determine prognosis at follow-up.
We prospectively included all consecutive patients discharged with a diagnosis of ischemic stroke from Valparaíso Regional Hospital between July 15, 2007 and January 15, 2008. Patient follow-up was performed at 5, 10, and 15 months using a standardized questionnaire. We used the Chi-square and Fisher exact tests to compare discrete variables and multivariate logistic regression analysis to adjust for potential confounding factors. A Cox regression model was fitted.
We included 156 patients; 128 patients (82%) completed follow-up. Adherence to oral anticoagulation decreased significantly compared to all other medications during follow-up (P = .004). This was not associated with any of the studied variables. Adherence to antihypertensives, statins, and hypoglycemic medications remained >65% without a significant variation. Patients with cardioembolic stroke had greater mortality (P = .003) and recurrence rates.
The observed significant decrease in adherence to oral anticoagulation in patients with cardioembolic stroke suggests a need for the implementation of specific strategies to achieve the desired secondary prevention goals in these patients. Future research into the evaluation of other factors that could be associated with the lack of adherence to these guidelines, measurements of therapeutic goals, and new therapeutic strategies that are easier to use and that are associated with less risk could improve the prognosis of these patients.
缺血性中风二级预防的临床指南已经制定，但这些指南的发布不足以使其发挥作用。我们的目的是调查对智利指南的遵循情况、其相关变量，并确定随访时的预后。
我们前瞻性纳入了2007年7月15日至2008年1月15日期间从瓦尔帕莱索地区医院出院、诊断为缺血性中风的所有连续患者。使用标准化问卷在5、10和15个月时对患者进行随访。我们使用卡方检验和费舍尔精确检验来比较离散变量，并使用多因素逻辑回归分析来调整潜在的混杂因素。拟合了Cox回归模型。
我们纳入了156例患者；128例患者（82%）完成了随访。在随访期间，与所有其他药物相比，口服抗凝药的依从性显著降低（P = 0.004）。这与任何研究变量均无关联。抗高血压药、他汀类药物和降糖药的依从性保持>65%，且无显著变化。心源性栓塞性中风患者的死亡率（P = 0.003）和复发率更高。
在心源性栓塞性中风患者中观察到的口服抗凝药依从性显著下降表明，需要实施特定策略以在这些患者中实现理想的二级预防目标。未来对可能与这些指南依从性不足相关的其他因素、治疗目标的测量以及更易于使用且风险更低的新治疗策略进行评估的研究，可能会改善这些患者的预后。
