Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke.

Autor: Gynnild MN; From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Aakerøy R; Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Spigset O; Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.; Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway., Askim T; From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway., Beyer MK; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway., Ihle-Hansen H; Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway.; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway., Munthe-Kaas R; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Drammen, Norway., Knapskog AB; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway., Lydersen S; Department of Mental Health, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway., Naess H; Department of Neurology, Haukeland University Hospital, Bergen, Norway.; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.; Institute of Clinical Medicine, University of Bergen, Bergen, Norway., Røsstad TG; Department of Health and Welfare Services, City of Trondheim, Trondheim, Norway., Seljeseth YM; Medical Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway., Thingstad P; From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway., Saltvedt I; From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.; Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Ellekjaer H; From the, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Jazyk: angličtina
Zdroj: Journal of internal medicine [J Intern Med] 2021 Mar; Vol. 289 (3), pp. 355-368. Date of Electronic Publication: 2020 Aug 19.
DOI: 10.1111/joim.13161
Abstrakt: Background: Studies regarding adequacy of secondary stroke prevention are limited. We report medication adherence, risk factor control and factors influencing vascular risk profile following ischaemic stroke.
Methods: A total of 664 home-dwelling participants in the Norwegian Cognitive Impairment After Stroke study, a multicenter observational study, were evaluated 3 and 18 months poststroke. We assessed medication adherence by self-reporting (4-item Morisky Medication Adherence Scale) and medication persistence (defined as continuation of medication(s) prescribed at discharge), achievement of guideline-defined targets of blood pressure (BP) (<140/90 mmHg), low-density lipoprotein cholesterol (LDL-C) (<2.0 mmol L -1 ) and haemoglobin A1c (HbA1c) (≤53 mmol mol -1 ) and determinants of risk factor control.
Results: At discharge, 97% were prescribed antithrombotics, 88% lipid-lowering drugs, 68% antihypertensives and 12% antidiabetic drugs. Persistence of users declined to 99%, 88%, 93% and 95%, respectively, at 18 months. After 3 and 18 months, 80% and 73% reported high adherence. After 3 and 18 months, 40.7% and 47.0% gained BP control, 48.4% and 44.6% achieved LDL-C control, and 69.2% and 69.5% of diabetic patients achieved HbA1c control. Advanced age was associated with increased LDL-C control (OR 1.03, 95% CI 1.01 to 1.06) and reduced BP control (OR 0.98, 0.96 to 0.99). Women had poorer LDL-C control (OR 0.60, 0.37 to 0.98). Polypharmacy was associated with increased LDL-C control (OR 1.29, 1.18 to 1.41) and reduced HbA1c control (OR 0.76, 0.60 to 0.98).
Conclusion: Risk factor control is suboptimal despite high medication persistence and adherence. Improved understanding of this complex clinical setting is needed for optimization of secondary preventive strategies.
(© 2020 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
Databáze: MEDLINE
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