Treatment with Multiple Therapeutic Classes of Medication Is Associated with Survival after Stroke

Monique F Kilkenny; Muideen T Olaiya; Lachlan L Dalli; Joosup Kim; Nadine E Andrew; Frank M Sanfilippo; Amanda G Thrift; Mark Nelson; Christopher Pearce; Lauren Sanders; Helen Dewey; Benjamin Clissold; Rohan Grimley; Dominique A Cadilhac

doi:10.1159/000520823

Treatment with Multiple Therapeutic Classes of Medication Is Associated with Survival after Stroke

Neuroepidemiology. 2022;56(1):66-74. doi: 10.1159/000520823. Epub 2021 Nov 10.

Authors

Monique F Kilkenny^{1

2}, Muideen T Olaiya¹, Lachlan L Dalli¹, Joosup Kim^{1

2}, Nadine E Andrew³, Frank M Sanfilippo⁴, Amanda G Thrift¹, Mark Nelson⁵, Christopher Pearce⁶, Lauren Sanders⁷, Helen Dewey⁸, Benjamin Clissold^{9

10}, Rohan Grimley^{1

11}, Dominique A Cadilhac^{1

2}

Affiliations

¹ School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
² The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
³ Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia.
⁵ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁶ Outcome Health, Blackburn, Victoria, Australia.
⁷ Department of Neurosciences, St Vincent's Hospital, Fitzroy, Victoria, Australia.
⁸ Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.
⁹ Neurosciences Department, Monash Health, Clayton, Victoria, Australia.
¹⁰ Neurosciences Department, Barwon Health, Geelong, Victoria, Australia.
¹¹ School of Medicine, Griffith University, Birtinya, Queensland, Australia.

PMID: 34758474
DOI: 10.1159/000520823

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Keywords: Adherence; Medication; Population register; Secondary prevention; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Australia
Female
Humans
Ischemic Attack, Transient* / drug therapy
Male
National Health Programs
Retrospective Studies
Secondary Prevention
Stroke* / prevention & control