School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
Neuroepidemiology. 2022;56(1):66-74. doi: 10.1159/000520823. Epub 2021 Nov 10.
Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analyzed the associations between the number of classes of prevention medications supplied within 90 days after discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival.
This is a retrospective cohort study of adults with first-ever IS/TIA (2010-2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e., blood pressure-lowering, antithrombotic, or lipid-lowering agents, supplied to patients within 90 days after discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days after hospital discharge was used to separate exposure and outcome periods, and only patients who survived until this date were included.
Of 8,429 patients (43% female, median age 74 years, 80% IS), 607 (7%) died in the year following 90 days after discharge. Overall, 56% of patients were supplied all 3 classes of medications, 28% 2 classes of medications, 11% 1 class of medications, and 5% no class of medications. Compared to patients supplied all 3 medication classes, adjusted hazard ratios for all-cause mortality ranged from 1.43 (95% confidence interval [CI]: 1.18-1.72) in those supplied 2 medication classes to 2.04 (95% CI: 1.44-2.88) in those supplied with no medication class.
DISCUSSION/CONCLUSION: Treatment with all 3 classes of guideline-recommended medications within 90 days after discharge was associated with better survival. Ongoing efforts are required to ensure optimal pharmacological intervention for secondary prevention of stroke.
对于缺血性脑卒中（IS）/短暂性脑缺血发作（TIA）的二级预防，推荐使用多种治疗类别的药物进行治疗。我们分析了在出院后 90 天内供应的预防药物种类与生存之间的关系。
这是一项回顾性队列研究，纳入了澳大利亚卒中临床登记处（2010-2014 年）中首次出现 IS/TIA 的成年人，这些患者的个人信息与国家药品和医疗保险理赔数据进行了单独链接。暴露因素是指在出院后 90 天内为 IS/TIA 患者供应的推荐药物种类，包括降压药、抗血栓药或降脂药。采用 Cox 比例风险回归模型，使用 landmark 方法评估了药物种类与生存之间的纵向关联。将出院后 90 天作为 landmark 日期，将暴露和结局期分开，仅纳入在此日期前存活的患者。
在 8429 例患者（43%为女性，中位年龄为 74 岁，80%为 IS）中，有 607 例（7%）在出院后 90 天内死亡。总体而言，56%的患者供应了所有 3 种药物，28%的患者供应了 2 种药物，11%的患者供应了 1 种药物，5%的患者未供应任何药物。与供应了所有 3 种药物的患者相比，供应了 2 种药物的患者全因死亡率的调整危险比范围为 1.43（95%置信区间[CI]：1.18-1.72），供应了 1 种药物的患者全因死亡率的调整危险比范围为 2.04（95% CI：1.44-2.88），供应了无药物的患者全因死亡率的调整危险比范围为 2.04（95% CI：1.44-2.88）。
讨论/结论：在出院后 90 天内供应所有 3 种指南推荐的药物与生存改善相关。需要持续努力，以确保对缺血性脑卒中的二级预防进行最佳药物治疗。
