TY - JOUR
T1 - Greater adherence to secondary prevention medications improves survival after stroke or transient ischemic attack
T2 - A linked registry study
AU - Dalli, Lachlan L.
AU - Kim, Joosup
AU - Cadilhac, Dominique A.
AU - Greenland, Melanie
AU - Sanfilippo, Frank M.
AU - Andrew, Nadine E.
AU - Thrift, Amanda G.
AU - Grimley, Rohan
AU - Lindley, Richard I.
AU - Sundararajan, Vijaya
AU - Crompton, Douglas E.
AU - Lannin, Natasha A.
AU - Anderson, Craig S.
AU - Whiley, Leanne
AU - Kilkenny, Monique F.
N1 - Funding Information:
Dr Cadilhac is the current Data Custodian for the Australian Stroke Clinical Registry (AuSCR). Drs Cadilhac, Lannin, Grimley, and Kilkenny are members of the AuSCR Steering or Management Committees. Dr Thrift is a member of the Board of the Stroke Foundation. Dr Grimley is the clinical lead for the Queensland Statewide Stroke Clinical Network and member of the Stroke Foundation Clinical Council. Dr Cadilhac reports receiving restricted grants from Amgen Australia, Boehringer Ingelheim, Ipsen, Medtronic, and Shire outside the submitted work. L. Whiley is a member of the Queensland Statewide Stroke Clinical Network and a Consumer Representative of the AuSCR Steering Committee. Dr Anderson reports receiving restricted grants from Boehringer Ingelheim, Allergan Australia, Ipsen, and Takeda outside the submitted work. Dr Grimley reports receiving restricted grants from Boehringer Ingelheim outside the submitted work. Dr Kilkenny reports receiving restricted grants from Amgen Australia outside the submitted work. The other authors report no conflicts.
Funding Information:
This study was funded by 2 seed grants from the Stroke Foundation of Australia (1715 and 1807). The Australian Stroke Clinical Registry (AuSCR) received funding from a range of government, nongovernment, and industry sources. L.L. Dalli is supported by an Australian Government Research Training Program Scholarship. The following authors acknowledge research fellowship support from the National Health and Medical Research Council of Australia: Drs Andrew (1072053) and Kilkenny (1109426); and Drs Thrift (1042600), Cadilhac (1154273). and Lindley (1149987). Dr Lannin acknowledges research fellowship support from the National Heart Foundation of Australia (GNT102055).
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - BACKGROUND AND PURPOSE: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. METHODS: Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010-June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, sex, socioeconomic position, stroke factors, primary care factors, and concomitant medication use. RESULTS: Among 8363 one-year survivors of first-ever stroke or TIA (44% aged ≥75 years, 44% female, 18% TIA), 75% were supplied antihypertensive agents. In patients without intracerebral hemorrhage (N=7446), 84% were supplied statins, and 65% were supplied nonaspirin antithrombotic medications. Median adherence was ≈90% for each medication group. Between 1% and 100% adherence, greater adherence to statins or antihypertensive agents, but not nonaspirin antithrombotic agents, was associated with improved survival. When restricted to linear regions above 60% adherence, each 10% increase in adherence was associated with a reduction in all-cause mortality of 13% for antihypertensive agents (hazard ratio, 0.87 [95% CI, 0.81-0.95]), 13% for statins (hazard ratio, 0.87 [95% CI, 0.80-0.95]), and 15% for nonaspirin antithrombotic agents (hazard ratio, 0.85 [95% CI, 0.79-0.93]). CONCLUSIONS: Greater levels of medication adherence after stroke or TIA are associated with improved survival, even among patients with near-perfect adherence. Interventions to improve medication adherence are needed to maximize survival poststroke.
AB - BACKGROUND AND PURPOSE: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. METHODS: Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010-June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, sex, socioeconomic position, stroke factors, primary care factors, and concomitant medication use. RESULTS: Among 8363 one-year survivors of first-ever stroke or TIA (44% aged ≥75 years, 44% female, 18% TIA), 75% were supplied antihypertensive agents. In patients without intracerebral hemorrhage (N=7446), 84% were supplied statins, and 65% were supplied nonaspirin antithrombotic medications. Median adherence was ≈90% for each medication group. Between 1% and 100% adherence, greater adherence to statins or antihypertensive agents, but not nonaspirin antithrombotic agents, was associated with improved survival. When restricted to linear regions above 60% adherence, each 10% increase in adherence was associated with a reduction in all-cause mortality of 13% for antihypertensive agents (hazard ratio, 0.87 [95% CI, 0.81-0.95]), 13% for statins (hazard ratio, 0.87 [95% CI, 0.80-0.95]), and 15% for nonaspirin antithrombotic agents (hazard ratio, 0.85 [95% CI, 0.79-0.93]). CONCLUSIONS: Greater levels of medication adherence after stroke or TIA are associated with improved survival, even among patients with near-perfect adherence. Interventions to improve medication adherence are needed to maximize survival poststroke.
KW - Antihypertensive agents
KW - Cerebral hemorrhage
KW - Medication adherence
KW - Mortality
KW - Secondary prevention
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85118966693&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.033133
DO - 10.1161/STROKEAHA.120.033133
M3 - Article
C2 - 34315251
AN - SCOPUS:85118966693
SN - 0039-2499
VL - 52
SP - 3569
EP - 3577
JO - Stroke
JF - Stroke
IS - 11
ER -