Faculty of Pharmacy (A15), University of Sydney, Science Road, Sydney, NSW, 2006, Australia,
Int J Clin Pharm. 2014 Apr;36(2):384-93. doi: 10.1007/s11096-013-9908-3. Epub 2014 Feb 12.
Stroke is one of the leading causes of death and disability. Significant proportions (33 %) of stroke presentations are by patients with a previous stroke or transient ischaemic attack. Consequently, the stroke management guidelines recommend that all ischaemic stroke patients should receive three key evidence-based preventive drug therapies: antihypertensive drug therapy, a statin and an antithrombotic drug therapy (anticoagulant and/or antiplatelet).
To determine the rates of utilization of the three key evidence-based drug therapies for the secondary prevention of stroke and to identify factors associated with use of treatment at discharge.
Five metropolitan hospitals in New South Wales, comprising two tertiary referral centres and three district hospitals.
A retrospective clinical audit was conducted in the study hospitals. Patients discharged with a principal diagnosis of ischaemic stroke during a 12-month time period (July 2009-2010) were identified for review.
The rate of utilization of each of the three key evidence-based drug therapies and the factors associated with use of treatment at discharge.
A total of 521 medical records were reviewed. Of these, 469 patients were discharged alive with a mean age of 73.6 ± 14.4 years. Overall, 75.4 % were prescribed an antihypertensive agent at discharge versus only 65.7 % on admission (P < 0.05). Three hundred-sixty patients (77.6 % of the eligible patients) were prescribed a statin at discharge (compared to only 43.9 % on admission, P < 0.05), of whom 74.0 % received monotherapy. Almost all (97.6 %) eligible patients were prescribed an antithrombotic drug therapy at discharge, of whom 68.5 % were prescribed monotherapy and 28.2 % were prescribed dual therapy. Only 60.0 % of eligible patients were discharged on all three key guideline recommended secondary preventive drug therapies. Multivariate logistic regression analyses showed that hypertension (OR 6.67; 95 % CI 4.35-11.11), hypercholesterolemia (OR 2.04; 95 % CI 1.32-3.23), and discharge destination (OR 0.22; 95 % CI 0.10-0.48) were associated with the utilization of all three guideline recommended therapies.
There is a scope for improvement in implementing the stroke management guidelines when it comes to prescribing secondary preventive drug therapies using antihypertensives, antithrombotics and statins. Appropriate risk/benefit assessment is indispensable for optimal prescribing and maximizing patient outcomes, particularly in older people.
中风是导致死亡和残疾的主要原因之一。相当比例（33%）的中风患者有先前的中风或短暂性脑缺血发作病史。因此，中风管理指南建议所有缺血性中风患者应接受三种关键的基于证据的预防药物治疗：抗高血压药物治疗、他汀类药物和抗血栓药物治疗（抗凝剂和/或抗血小板药物）。
确定三种关键的基于证据的药物治疗方法在中风二级预防中的使用率，并确定与出院时治疗使用相关的因素。
新南威尔士州的五家大都市医院，包括两家三级转诊中心和三家地区医院。
在研究医院进行回顾性临床审计。在 12 个月的时间内（2009 年 7 月至 2010 年），确定了因主要诊断为缺血性中风出院的患者进行审查。
三种关键的基于证据的药物治疗方法的使用率以及与出院时治疗使用相关的因素。
共审查了 521 份病历。其中，469 名患者存活出院，平均年龄为 73.6 ± 14.4 岁。总体而言，出院时 75.4%的患者被开具了降压药物，而入院时仅为 65.7%（P<0.05）。360 名患者（合格患者的 77.6%）出院时开具了他汀类药物（而入院时仅为 43.9%，P<0.05），其中 74.0%接受了单药治疗。几乎所有（97.6%）合格患者出院时都开具了抗血栓药物治疗，其中 68.5%接受了单药治疗，28.2%接受了双联治疗。只有 60.0%的合格患者出院时接受了所有三种指南推荐的二级预防药物治疗。多变量逻辑回归分析显示，高血压（OR 6.67；95%CI 4.35-11.11）、高胆固醇血症（OR 2.04；95%CI 1.32-3.23）和出院目的地（OR 0.22；95%CI 0.10-0.48）与使用所有三种指南推荐的治疗方法相关。
在开具抗高血压药、抗血栓药和他汀类药物等二级预防药物治疗方面，实施中风管理指南仍有改进的空间。适当的风险/效益评估对于最佳处方和最大限度地提高患者预后至关重要，特别是在老年人中。
