Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom.
Department of Cardiovascular Sciences, University of Leicester, United Kingdom.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106665. doi: 10.1016/j.jstrokecerebrovasdis.2022.106665. Epub 2022 Jul 25.
Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence.
One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables.
The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01).
LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events.
短暂性脑缺血发作（TIA）诊所对于致命或致残性中风的二级预防至关重要。不遵医嘱服药是治疗失败的一个重要原因，但难以诊断。本研究旨在确定一种新的生化工具在客观生化诊断不依从方面的效用。
从一家三级中心的 TIA 诊所就诊的 100 例连续尿液样本中，使用液相色谱-质谱联用（LC-MS/MS）分析是否存在规定的心血管药物。患者分别被归类为依从或不依从。比较两组患者的人口统计学和临床特征。对个体变量进行单变量回归分析，并对显著变量进行模型拟合。
从首发事件到随访的平均时间为 31 天（标准差[SD]：18.9）。至少一种药物不依从的总发生率为 24%。在单变量分析中，不依从组的合并症数量[3.4（SD：1.9）比 2.5（1.9），P=0.032]和所有规定药物的总数[6.0（3.3）比 4.4（2.1），P=0.032]更高。多变量分析显示，规定药物的总数与不依从的增加相关（比值比：1.27，95%置信区间：1.1-1.5，P=0.01）。
LC-MS/MS 是诊断不依从的一种有用的临床工具。近四分之一的 TIA 患者不依从心血管药物。早期解决不依从问题可能会降低未来致残性心血管事件的风险。
