Tsai Jenny P, Rochon Paula A, Raptis Stavroula, Bronskill Susan E, Bell Chaim M, Saposnik Gustavo
Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Women's College Research Institute, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
J Stroke Cerebrovasc Dis. 2014 Oct;23(9):2308-15. doi: 10.1016/j.jstrokecerebrovasdis.2014.04.026. Epub 2014 Aug 20.
Medication adherence is important for optimal secondary stroke prevention. We evaluated short-term adherence to antihypertensive and lipid-lowering agents after a new ischemic stroke, as predictor of adherence at 1 and 2 years.
A 5-year cohort of patients from 11 institutions in the Registry of the Canadian Stroke Network was linked to population-based administrative health records. Patients diagnosed with acute ischemic stroke and discharged home were included. Medication adherence was assessed through documented prescription filling at 7 days, 1 year, and 2 years.
From 2003 to 2008, 6437 ischemic stroke patients were discharged home from hospital, and 1126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of discharge. Patients provided with a prescription at discharge were more likely to show adherence at 7 days. Adherence at 1 year remains higher in these patients for antihypertensive (93.8% vs. 87.7%; odds ratio [OR], 2.31; 95% confidence interval [CI], 1.69-3.16), lipid-lowering agents (88% vs. 81.6%; OR, 1.77; 95% CI, 1.36-2.32), or both (85.8% vs. 79.9%; OR, 1.72; 95% CI, 1.32-2.25). Findings are similar at 2 years for antihypertensive (92.2% vs. 87.7%; OR, 1.78; 95% CI, 1.3-2.43), lipid-lowering agents (82.6% vs. 79.0%; OR, 1.31; 95% CI, 1.01-1.69), or both (81.1% vs. 77.0%; OR, 1.4; 95% CI, 1.09-1.82).
Provision of a prescription strengthens adherence at 1 week from discharge for both prior and new users of antihypertensive and lipid-lowering drugs. Medication adherence at 1 week after discharge for acute ischemic stroke predicts adherence for secondary preventive therapies at 1 and 2 years.
药物依从性对于优化二级卒中预防至关重要。我们评估了新发缺血性卒中后短期对抗高血压药和降脂药的依从性，作为1年和2年依从性的预测指标。
加拿大卒中网络登记处11家机构的5年队列患者与基于人群的行政健康记录相链接。纳入诊断为急性缺血性卒中并出院回家的患者。通过记录出院7天、1年和2年时的处方配药情况来评估药物依从性。
2003年至2008年，6437例缺血性卒中患者出院回家，1126例患者在出院7天内开具了抗高血压药和降脂药的处方。出院时开具处方的患者在7天时更有可能表现出依从性。这些患者在1年时对抗高血压药（93.8%对87.7%；优势比[OR]，2.31；95%置信区间[CI]，1.69 - 3.16）、降脂药（88%对81.6%；OR，1.77；95% CI，1.36 - 2.32）或两者（85.8%对79.9%；OR，1.72；95% CI，1.32 - 2.25）的依从性仍然更高。在2年时，抗高血压药（92.2%对87.7%；OR，1.78；95% CI，1.3 - 2.43）、降脂药（82.6%对79.0%；OR，1.31；95% CI，1.01 - 1.69）或两者（81.1%对77.0%；OR，1.4；95% CI，1.09 - 1.82）的结果相似。
开具处方可增强抗高血压药和降脂药既往使用者和新使用者出院1周时的依从性。急性缺血性卒中出院1周时的药物依从性可预测1年和2年二级预防治疗的依从性。
