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Baker D, Cruddas L, Eveson T, Bakhai A, Penge J. Patient Acceptance and Adherence to the COMPASS Trial Drug Recommendations Following Symptomatic Carotid Endarterectomy. Ann Vasc Surg 2024; 108:403-409. [PMID: 39009129 DOI: 10.1016/j.avsg.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The COMPASS trial demonstrated that in patients with atherosclerotic diseases, low-dose rivaroxaban and aspirin provides greater protection against subsequent major adverse cardiovascular events (MACEs) than mono-antiplatelet therapy (MAPT) alone. Drug acceptance and adherence maximizes this benefit. We have assessed drug acceptance and adherence to the COMPASS drug regime in patients following carotid endarterectomy (CEA) for symptomatic carotid artery stenosis. METHODS Following CEA, the views of 63 patients on the COMPASS drug regime were assessed using the Beliefs about Medicine Questionnaire and drug adherence was determined using the Sidorkiewicz scoring system. These views were compared with those of 54 patients on MAPT. Side effects (bleeding and drug reactions) and new MACE were recorded. RESULTS Post-CEA patients on the COMPASS drug regimen had strong positive views on the necessity to take these drugs (necessity scale 19.6 ± 3.6). Although there were some concerns about the COMPASS drug regimen, these were not strongly held (concern cscale 11.8 ± 4.9) and the necessity-concerns differential was positive (7.8 ± 6.2). The Drug Adherence Score was "High" to "Good" (level of drug adherence 1.7 ± 1.0). The Beliefs about Medicine Questionnaire scales and Drug Adherence Score of post-CEA patients on the COMPASS drug regimen were similar to those on MAPT. The incidence of post-CEA MACE and side effects were similar for those on the COMPASS drug regimen and MAPT. CONCLUSIONS Post-CEA patients on the COMPASS drug regimen had positive views on taking the drugs and drug adherence was high. We did not identify any patient-related barriers to the use of the COMPASS drug regimen to further reduce cardiovascular events.
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Affiliation(s)
- Daryll Baker
- Department of Vascular Surgery, Royal Free London NHS Foundation, Trust, London, UK; Vascular Surgery Service, The National Hospital for Neurology and, Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
| | - Lucinda Cruddas
- Department of Vascular Surgery, Royal Free London NHS Foundation, Trust, London, UK; UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Tom Eveson
- Department of Vascular Surgery, Royal Free London NHS Foundation, Trust, London, UK
| | - Ameet Bakhai
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK; Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
| | - Justin Penge
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK; Department of Stroke Medicine, Royal Free London NHS Foundation Trust, London, UK
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2
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Hoarau D, Ramos I, Termoz A, Fernandez V, Rambure M, Allemann SS, Derex L, Haesebaert J, Schott AM, Viprey M. Determinants of adherence to post-stroke/transient ischemic attack secondary prevention medications: A cohort study. Eur J Neurol 2024:e16395. [PMID: 38953278 DOI: 10.1111/ene.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Adherence to post-stroke secondary prevention medications mitigates recurrence risk. This study aimed to measure adherence to secondary prevention medications during 3 years post-ischemic stroke/transient ischemic attack, using prescription and dispensing data, and identify factors associated with suboptimal adherence. METHODS This multicenter, prospective, cohort study involved patients from the STROKE 69 cohort, which included all consecutive patients with suspected acute stroke admitted between November 2015 and December 2016 to any emergency department or stroke center in the Rhône area in France. Prescription data for antihypertensive agents, antidiabetic agents, lipid-lowering drugs, and antithrombotics were collected. Dispensing data were provided by the French regional reimbursement database. Adherence was calculated using the continuous medication acquisition index. Associations between suboptimal adherence and potential influencing factors across the World Health Organization's five dimensions were explored through univariate and multivariate analyses. RESULTS From 1512 eligible patients, 365 were included. Optimal adherence to overall treatment (≥90%) was observed in 61%, 62%, and 65% of patients in the first, second, and third years, respectively. Education level (high school diploma or higher: OR = 3.24, 95% CI [1.49; 7.36]) and depression (Hospital Anxiety and Depression Scale-Depression scores 8-10: OR = 1.90, 95% CI [1.05; 3.44]) were significantly associated with suboptimal adherence. CONCLUSIONS Overall adherence to secondary prevention medications was fairly good. Having an initial diagnosis of transient ischemic attack, a high level of education, or depression was associated with increased odds of suboptimal adherence, while having a history of heart rhythm disorder was associated with lower odds.
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Affiliation(s)
- Damien Hoarau
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Inès Ramos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | | | - Marie Rambure
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Comprehensive Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Marie Viprey
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
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Babu V, Sylaja PN, Soman B, Varma RP, Ms M, Gl G, Kumar B S. A randomized controlled trial of medication adherence and management of risk factors for secondary prevention of stroke (MaMoRS) using a smartphone-based application. Int J Stroke 2024; 19:654-664. [PMID: 38533606 DOI: 10.1177/17474930241245612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND There are little data on the use of smartphone-based applications for medication adherence and risk-factor control for the secondary prevention of stroke in low-and-middle-income countries (LMICs). AIMS The aim was to determine whether a smartphone-based app improved medication adherence, risk-factor control, and provided health education to stroke survivors for lifestyle and behavioral modifications. METHODS An unblinded, single-center randomized controlled double arm trial with 1:1 allocation among stroke survivors was performed in South India. The primary outcome was medication adherence, with co-primary outcomes of lifestyle and behavioral factors and control of vascular risk factors, at 3 and 6 months. RESULTS Among 351 stroke survivors screened, 209 were recruited. The mean (standard deviation (SD)) age of the intervention (n = 105) group was 60 (12) years and that of the control (n = 104) group was 60 (10) years. In the primary outcome, mean medication adherence significantly improved in the intervention group with a between group difference of 0.735 (95% confidence interval (CI) = 0.419 to 1.050), p < 0.001. Being in intervention group (OR = 4.5; 95% CI = 2.3 to 8.9), stroke recurrence (OR = 3.3 (95% CI = 1.9 to 7.8)), and regular physician visits (OR = 2.1; 95% CI = 1.0 to 4.4) were significant predictors of good medication adherence. Considering the co-primary outcomes, compared to the control group, participants in the intervention group had a greater improvement in self-reported healthy diet intake (p = 0.003), intake of fruits (p = 0.005), and were physically more active (p = 0.001). At 6 months, mean fasting blood sugar (p = 0.005) and high-density lipoprotein cholesterol higher (p = 0.024) in the intervention group. CONCLUSIONS The use of a mobile app is an effective method to improve medication adherence and risk-factor control in stroke survivors and is feasible in LMICs like India. DATA ACCESS STATEMENT Data used during the study are available from the corresponding author on request. TRIAL REGISTRATION The study is registered in Clinical Trial Registry of India (CTRI/2022/06/042980).
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Affiliation(s)
- Veena Babu
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - P N Sylaja
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Manju Ms
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Geethu Gl
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | - Suresh Kumar B
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India
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Kengne AP, Brière JB, Zhu L, Li J, Bhatia MK, Atanasov P, Khan ZM. Impact of poor medication adherence on clinical outcomes and health resource utilization in patients with hypertension and/or dyslipidemia: systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:143-154. [PMID: 37862440 DOI: 10.1080/14737167.2023.2266135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION We aimed to summarize evidence on the effect of poor medication adherence on clinical outcomes and health resource utilization (HRU) among patients with hypertension and/or dyslipidemia. AREAS COVERED A systematic review of studies reporting clinical outcomes and HRU for patients by status of adherence to antihypertensives and/or lipid-lowering medications was searched using Embase, MEDLINE, and MEDLINE In-Process and supplemented by manual searches of conference abstracts. In total, 45 studies were included, with most being retrospective observational studies (n = 36). Patients with poor adherence to antihypertensives and lipid-lowering medications compared with those with good adherence showed less reduction of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-c) after 6-12 months follow-up (∆ systolic BP: 1.2 vs. -4.5 mmHg; ∆LDL-c: -14.0 to -18.9 vs. -34.1 to -42.0 mg/dL). Poor adherence was also significantly associated with a higher risk of cardiovascular events (HR: 1.1-1.9) and mortality (HR: 1.4-1.8) in patients with hypertension and dyslipidemia and increased HRU (i.e. outpatient visits, risk of cardiovascular-related and all-cause hospitalization, annual inpatient days, total health-care costs). EXPERT OPINION Poor adherence is associated with poor clinical outcomes and increased HRU, highlighting the need to enhance medication adherence in patients with hypertension and/or dyslipidemia.
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Affiliation(s)
- André Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Lucía Zhu
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Jingya Li
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | | | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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Emanuel S, Kaba RA, Delanerolle G, Field BCT, Lip GYH, de Lusignan S. Correct dosing, adherence and persistence of DOACs in atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis. Open Heart 2023; 10:e002340. [PMID: 37419525 DOI: 10.1136/openhrt-2023-002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and atrial fibrillation (AF) are increasing in prevalence globally and share common risk factors.Our aim was to characterise real-world evidence on direct oral anticoagulant (DOAC) prescribing for people with AF and CKD, in terms of adherence, persistence and renal dose titration. METHODS PubMed, EMBASE and CINAHL were searched from inception to June 2022. Our search terms included a combination of Medical Subject Headings (MeSH) terms and keywords including 'atrial fibrillation', 'chronic kidney disease', 'adherence', 'persistence', 'direct oral anticoagulants' and 'dosing'. Data extraction and quality assessment were undertaken by two reviewers independently. Meta-analyses for pooled estimates were performed using DerSimonian and Laird random-effects models. Age, sex, diabetes, hypertension and heart failure were chosen as variables of interest. RESULTS From 19 studies, a total of 252 117 patients were included with CKD and AF. Meta-analysis was only possible in seven studies with 128 406 patients, five on DOAC dose titration and two on adherence. There were insufficient studies on persistence. Our meta-analysis of dosing showed that 68% of patients with CKD and AF had correct dosing. There was no evidence to show any association between correct DOAC dosing and variables of interest. Overall, 67% of patients were DOAC adherent. CONCLUSION Adherence and correct dosing of DOACs were suboptimal compared with other medications in the pooled studies with respect to CKD and AF. Thus, further research is required as the lack of generalisation of findings is a rate-limiting factor for improved DOAC management in AF and CKD. PROSPERO REGISTRATION NUMBER CRD;42022344491.
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Affiliation(s)
- Subo Emanuel
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Riyaz A Kaba
- Cardiovascular Clinical Academic Group,Molecular and Clinical Sciences Institute, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
- Department of Biological Sciences, Royal Holloway, University of London, London, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Winchester, UK
| | - Benjamin C T Field
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Department of Diabetes and Endocrinology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, London, UK
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Kohlhase K, Schäfer JH, Tako LM, Willems LM, Hattingen E, Bohmann FO, Grefkes C, Rosenow F, Strzelczyk A. Large-vessel-occlusion in patients with previous ischemic stroke: an analysis of adherence to secondary preventive medication for different etiologies. Neurol Res Pract 2023; 5:22. [PMID: 37226225 PMCID: PMC10210396 DOI: 10.1186/s42466-023-00247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Large vessel occlusion (LVO) is a severe condition that carries a high risk of morbidity and mortality, underscoring the importance of effective prevention strategies. This retrospective study aimed to analyze the intake of preventive medication at the time of hospitalization in a cohort of recurrent stroke patients presenting with acute LVO. METHODS The study assessed the intake of either platelet aggregation inhibitors (PAI), oral anticoagulants (OAC) or statins at admission in patients with recurrent stroke and correlated it with the final classification of LVO. The frequency of those secondary preventive medication in recurrent stroke patients was defined as primary endpoint. The Modified Rankin Scale (mRS) at discharge was used as a functional outcome and defined as a secondary outcome measure. RESULTS This study included 866 patients who were treated for LVO between 2016 and 2020, of whom 160 (18.5%) had a recurrent ischemic stroke. OAC (25.6% vs. 14.1%, p < 0.01), PAI (50.0% vs. 26.0%, p < 0.01), or statin therapy (50.6% vs. 20.8%, p < 0.01) at admission were significantly more frequent in recurrent stroke patients compared to patients with a first-time stroke. Concerning LVO etiology in recurrent stroke patients, OAC at admission was taken in 46.8% of cardioembolic LVO, whereas PAI and statin at admission in macroangiopathic LVO were administered to 40.0%; neither PAI nor OAC was taken in 26.0%, 28.3%, and 31.6% of cardioembolic, macroangiopathic, or cryptogenic strokes, respectively. Regardless of stroke recurrence or etiology, there was an increase in mRS at discharge. CONCLUSIONS Despite high-quality healthcare, this study suggested a significant proportion of patients with recurrent stroke who were either non-adherent or insufficiently adherent to secondary preventive medication. Given the disability associated with LVO, improving patients' medication adherence and identifying unknown stroke causes are crucial for effective prevention strategies.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jan Hendrik Schäfer
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Marie Tako
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Laurent M Willems
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ferdinand O Bohmann
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Grefkes
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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7
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Cao W, Kadir AA, Wang J, Hu L, Wen L, Yu M, Peng L, Chen L, Luo N, Hassan II. Medication non-adherence and associated factors among older adult stroke survivors in China. Front Pharmacol 2022; 13:1054603. [PMID: 36506570 PMCID: PMC9731135 DOI: 10.3389/fphar.2022.1054603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Aim: Medication non-adherence has remained a common and costly global health issue of growing importance among older adults. This study aims to determine the prevalence and associated factors related to medication non-adherence among older adult stroke survivors in China. Methods and results: In this cross-sectional study, a total of 402 older adult stroke survivors were recruited from three tertiary hospitals in China. The results of the survey showed that 61.4% exhibited medication non-adherence. The chances of medication non-adherence among older adult stroke survivors who had primary school or less educational levels were higher than those who had senior secondary and junior college educational levels [OR (95% CI) = 0.440(0.249, 0.778)] as well as those who had a bachelor's degree or above educational levels [OR (95%CI) = 0.367(0.202, 0.667)]. Moreover, the probability of medication non-adherence with 4-5 and ≥6 types of total prescription medications per day increased by 1.993 times [OR (95% CI) = 1.993(1.190, 3.339))] and 2.233 times [OR (95%CI) = 2.233(1.159, 4.300)], respectively, as compared to when there were ≤3 types. Furthermore, medication non-adherence decreased with the increase in health literacy scores (β = -0.641 (95% CI; (0.913, 0.965)) and BMQ specific-necessity scores (β = -0.131 (95% CI; 0.806, 0.995)). On the other hand, when the BMQ specific-concerns score increased by one unit, medication non-adherence increased by 11.1% [OR (95% CI) = 1.111(1.044, 1.182)]. Conclusion: The present study found that patient medication adherence among older adult stroke survivors in China is problematic and associated with educational levels, total prescribed drugs per day, beliefs about medication, and health literacy scores. This indicates that measures should be taken to enhance medication adherence among such higher-risk populations.
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Affiliation(s)
- Wenjing Cao
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia,Xiang Nan University, Chenzhou, Hunan, China
| | - Azidah Abdul Kadir
- School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Juan Wang
- Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Lin Hu
- Xiang Nan University, Chenzhou, Hunan, China
| | - Linlan Wen
- Chenzhou No.1 People’s Hospital, Chenzhou, Hunan, China
| | - Mei Yu
- Chenzhou Third People’s Hospital, Chenzhou, Hunan, China
| | - Liqun Peng
- Affiliated hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Lanying Chen
- Affiliated hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Na Luo
- Xiang Nan University, Chenzhou, Hunan, China
| | - Intan Idiana Hassan
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia,*Correspondence: Intan Idiana Hassan, ,
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8
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Yang M, Cheng H, Wang X, Ouyang M, Shajahan S, Carcel C, Anderson C, Kristoffersen ES, Lin Y, Sandset EC, Wang X, Yang J. Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta-analysis. Brain Behav 2022; 12:e2752. [PMID: 36067030 PMCID: PMC9575604 DOI: 10.1002/brb3.2752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. METHODS We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle-Ottawa scale. Where possible, data were pooled using random-effects meta-analysis. RESULTS We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%-68%), and 68% (95% CI: 58%-79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%-93%). It was reported that 11% (95% CI: 2%-19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%-89%), 71% (95% CI: 57%-84%), and 73% (95% CI: 59%-86%), respectively. CONCLUSION In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.
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Affiliation(s)
- Min Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Hang Cheng
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Sultana Shajahan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, Helsam, University of Oslo, Oslo, Norway
| | - Yapeng Lin
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.,International Clinical Research Center, Chengdu Medical College, Chengdu, China
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Xiaoyun Wang
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Adherence to Post-Stroke Pharmacotherapy: Scale Validation and Correlates among a Sample of Stroke Survivors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081109. [PMID: 36013576 PMCID: PMC9413934 DOI: 10.3390/medicina58081109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Adherence to post-stroke pharmacotherapy has been less studied compared with other cardiovascular diseases, and previous research in this context utilized generic tools without cross-validating for stroke specific factors and patient characteristics. This study aimed to validate the Lebanese Medication Adherence Scale (LMAS-14) among stroke survivors to assess adherence to post-stroke pharmacotherapy. It also aimed to determine the socioeconomic, clinical characteristics, and health related quality of life correlates of medication adherence among stroke survivors. Materials and Methods: This was a cross-sectional study that included stroke survivors from districts throughout Lebanon. A well-structured questionnaire consisting of three parts was developed and utilized to collect data. The first part included questions about the sociodemographic and socioeconomic characteristics. The second part included questions about medical history, current clinical characteristics of the patients, and use of medications. The third part included validated scales to assess stroke outcomes, daily performance and activities, and quality of life. Results: A total of 172 stroke survivors were included. The LMAS-14 structure was validated over a solution of three factors, with a Kaiser−Meyer−Olkin (KMO) measure of sampling adequacy = 0.836 and a significant Bartlett’s test of sphericity (p < 0.001). Severe difficulty in obtaining medications within the current Lebanese economic crisis was significantly associated with lower medication adherence (Beta = −8.473, p = 0.001). Lower medication adherence was also associated with poor stroke prognosis (Beta = −3.264, p = 0.027), higher number of used medications (Beta = −0.610, p = 0.034), and longer duration of stroke diagnosis (Beta = −4.292, p = 0.002). Conclusions: The LMAS−14 is a valid and reliable tool to assess medication adherence in stroke practice and research. Severe difficulty in obtaining medications due to unpredictable availability and shortage of supplies is associated with lower medication adherence, and thus places stroke survivors at higher risk of complications and morality. Additional measures and urgent action by stroke care providers and public health stakeholders are necessary to ensure adequate post-stroke management and outcomes.
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10
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Dalli LL, Kilkenny MF, Arnet I, Sanfilippo FM, Cummings DM, Kapral MK, Kim J, Cameron J, Yap KY, Greenland M, Cadilhac DA. Towards better reporting of the Proportion of Days Covered method in cardiovascular medication adherence: A scoping review and new tool TEN-SPIDERS. Br J Clin Pharmacol 2022; 88:4427-4442. [PMID: 35524398 PMCID: PMC9546055 DOI: 10.1111/bcp.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Although medication adherence is commonly measured in electronic datasets using the proportion of days covered (PDC), no standardized approach is used to calculate and report this measure. We conducted a scoping review to understand the approaches taken to calculate and report the PDC for cardiovascular medicines to develop improved guidance for researchers using this measure. After prespecifying methods in a registered protocol, we searched Ovid Medline, Embase, Scopus, CINAHL Plus and grey literature (1 July 2012 to 14 December 2020) for articles containing the terms “proportion of days covered” and “cardiovascular medicine”, or synonyms and subject headings. Of the 523 articles identified, 316 were reviewed in full and 76 were included (93% observational studies; 47% from the USA; 2 grey literature articles). In 45 articles (59%), the PDC was measured from the first dispensing/claim date. Good adherence was defined as 80% PDC in 61 articles, 56% of which contained a rationale for selecting this threshold. The following parameters, important for deriving the PDC, were often not reported/unclear: switching (53%), early refills (45%), in‐hospital supplies (45%), presupply (28%) and survival (7%). Of the 46 articles where dosing information was unavailable, 59% reported how doses were imputed. To improve the transparent and systematic reporting of the PDC, we propose the TEN‐SPIDERS tool, covering the following PDC parameters: Threshold, Eligibility criteria, Numerator and denominator, Survival, Presupply, In‐hospital supplies, Dosing, Early Refills, and Switching. Use of this tool will standardize reporting of the PDC to facilitate reliable comparisons of medication adherence estimates between studies.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Western Australia, Australia
| | - Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.,Centre for Health Disparities, East Carolina University, Greenville, North Carolina, USA
| | - Moira K Kapral
- ICES, Toronto, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Victoria, Australia.,Australian Centre for Heart Health, Victoria, Australia
| | - Kevin Y Yap
- Department of Pharmacy, Singapore General Hospital, Singapore.,School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK.,Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
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11
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Norberg H, Sjölander M, Glader EL, Gustafsson M. Self-reported medication adherence and pharmacy refill adherence among persons with ischemic stroke: a cross-sectional study. Eur J Clin Pharmacol 2022; 78:869-877. [PMID: 35156130 PMCID: PMC9005421 DOI: 10.1007/s00228-022-03284-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
Purpose To describe and compare self-reported medication adherence assessed with the 5-item version of Medication Adherence Report Scale (MARS-5) and pharmacy refill adherence based on data from the Swedish Prescribed Drug Register (SPDR) among persons with ischemic stroke, and to investigate independent predictors associated with respective assessments. Methods A study questionnaire was sent to persons with ischemic stroke registered in the Swedish Stroke Register between Dec 2011 and March 2012, and who lived at home 3 months after discharge. The primary outcome was dichotomized to adherent/non-adherent based on MARS-5 and SPDR and analyzed with multivariable logistic regression. Adherence according to MARS-5 was defined as score 23 or higher (out of 25). Adherence according to SPDR was defined as at least one filled statin prescription recorded in SPDR in each 6-month interval during 2 years of follow-up. Results Of 420 participants, 367 (87%) and 329 (78%) were adherent according to MARS-5 and SPDR, respectively, and 294 (70%) participants were adherent according to both assessments. A significant association was shown between medication adherence according to the two assessments (p = 0.020). Independent predictors associated with medication adherence according to MARS-5 were female sex, while factors associated with SPDR were male sex and being younger. Conclusions The majority of participants were classified as adherent, 87% according to MARS-5 and 78% based on data from SPDR. However, only 70% were adherent according to both MARS-5 and SPDR, and different predictors were associated with the different measurements, suggesting that these assessments are measuring different aspects of adherence. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03284-4.
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Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden.
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umea, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, S-901 87, Umea, Sweden
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12
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Westberg A, Sjölander M, Glader EL, Gustafsson M. Primary Non-Adherence to Preventive Drugs and Associations with Beliefs About Medicines in Stroke Survivors. Patient Prefer Adherence 2022; 16:343-352. [PMID: 35177898 PMCID: PMC8844454 DOI: 10.2147/ppa.s351001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication non-adherence is a common problem in clinical practice. Little is known about stroke survivors' primary non-adherence to preventive drugs, and we hypothesised that their beliefs about medicines are associated with primary non-adherence. The objective was to describe primary non-adherence among stroke survivors and to assess associations between primary non-adherence to preventive drugs and beliefs about medicines. METHODS Questionnaires were sent to 797 individuals 3 months after stroke to assess beliefs about medicines through the Beliefs about Medicines Questionnaire (BMQ). All participants were registered in the Swedish Stroke Register (Riksstroke), and prescriptions for new preventive drugs during the hospital stay were identified through data from Riksstroke. Primary non-adherers were those who failed to fill one or more new prescriptions within 1 month of hospital discharge based on data from the Swedish Prescribed Drug Register. Differences between primary non-adherers and adherers were assessed by 2 tests and associations between the BMQ subscales and primary non-adherence were analysed using independent two-sample t-tests and multivariable logistic regression models. RESULTS A total of 594 individuals responded to the survey, of which 452 received new prescriptions of preventive drugs. Overall, 53 (12%) participants were classified as primary non-adherent. Primary non-adherers were more often dependent on help or support from next of kin (p=0.032) and had difficulties with memory more often (p=0.002) than the primary adherent individuals. No statistically significant differences in BMQ subscale-scores were found between the two groups (p>0.05). CONCLUSION Primary non-adherence to preventive drugs was low, and no associations were found between primary non-adherence and beliefs about medicines. Associations with cognitive impairments such as difficulties with memory and need for help from next of kin suggest that more effort is needed to help stroke survivors to start important preventive drug treatments after discharge from hospital.
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Affiliation(s)
- Annica Westberg
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden
- Correspondence: Maria Gustafsson, Department of Integrative Medical Biology, Umeå University, Umeå, SE-901 87, Sweden, Email
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13
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Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8110146. [PMID: 34821699 PMCID: PMC8624664 DOI: 10.3390/jcdd8110146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Aims: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. Methods: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. Results: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88–0.94), 7% (RR 0.93, 95% CI: 0.84–1.03), and 10% (RR 0.90, 95% CI: 0.88–0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81–0.87), 17% (RR 0.83, 95% CI: 0.78–0.89), and 13% (RR 0.87, 95% CI: 0.84–0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87–0.92), 12% (RR 0.88, 95% CI: 0.82–0.94), and 9% (RR 0.91, 95% CI: 0.89–0.94). Conclusions: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.
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14
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Kamal H, Khodery M, Elnady H, Borai A, Schaefer JH, Fawi G, Steinmetz H, Foerch C, Spitzer D. Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis. Cerebrovasc Dis 2021; 50:200-207. [PMID: 33477136 DOI: 10.1159/000512610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of stroke weighs heavily in developing countries where recurrence rates clearly exceed that of developed countries. The impact of nonadherence to antithrombotic treatment within this context has been poorly investigated. OBJECTIVE The objective of this study was to evaluate patients with recurrent ischemic stroke in Egypt and Germany with focus on stroke subtype distribution and adherence to antithrombotic therapy. METHODS We conducted a comparative cross-sectional retrospective cohort study enrolling consecutive patients hospitalized for recurrent ischemic stroke in 2017 in 2 academic centers. Data were collected on demographics, risk factors, stroke subtypes, and medication adherence. Nonadherence to antithrombotic agents was analyzed at the time point of index stroke (recurrent stroke). Predictors of nonadherence were analyzed using logistic regression. RESULTS A total of 373 Egyptian and 468 German patients with ischemic stroke were included. The proportion of recurrent ischemic stroke among all patients was higher in the Egyptian cohort compared to the German cohort (33 vs. 10%, p < 0.05). Small-vessel occlusion stroke was the most frequent subtype in Egyptians, with a significantly greater proportion than in Germans (45 vs. 26%, p < 0.05). Nonadherence to antiplatelets at the time point of the recurrent stroke was higher in Egyptians than in Germans (82 vs. 19%, p < 0.001). Low educational attainment among Egyptians (OR 0.14, 95% CI [0.00-0.19], p < 0.01) and high comorbidity scores among Germans (OR 2.45, 95% CI [1.06-5.66], p < 0.05) were found to be predictors of nonadherence to antithrombotic treatment. CONCLUSIONS The large stroke recurrence burden in Egypt may be partly explained by differing adherence to secondary preventative antithrombotic pharmacotherapy. Predictors of medication nonadherence have to be addressed to reduce stroke recurrence disparities.
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Affiliation(s)
- Hazem Kamal
- Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Sohag, Egypt
| | - Mohamed Khodery
- Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Sohag, Egypt
| | - Hassan Elnady
- Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Sohag, Egypt
| | - Ahmed Borai
- Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Sohag, Egypt
| | - Jan Hendrik Schaefer
- Department of Neurology, University Hospital/Goethe University Frankfurt, Frankfurt, Germany
| | - Gharib Fawi
- Department of Neurology and Psychological Medicine, Sohag University, Sohag Governorate, Sohag, Egypt
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital/Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital/Goethe University Frankfurt, Frankfurt, Germany
| | - Daniel Spitzer
- Department of Neurology, University Hospital/Goethe University Frankfurt, Frankfurt, Germany, .,Edinger Institute (Institute of Neurology), University Hospital/Goethe University Frankfurt, Frankfurt, Germany,
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15
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Ouk M, Wu CY, Colby-Milley J, Fang J, Zhou L, Shah BR, Herrmann N, Lanctôt KL, Linkewich E, Law M, Swartz RH, Kapral MK, Black SE, MacIntosh BJ, Edwards JD, Swardfager W. Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke. Stroke 2020; 51:3531-3540. [DOI: 10.1161/strokeaha.120.031068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose:
Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression.
Methods:
Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke.
Results:
Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X
2
=5.4;
P
=0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR
Depression
=1.57 [1.24–1.98]) and incident dementia (aHR
Depression
=1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR
Diabetes
=1.20 [1.12–1.29]; aHR
Depression
=1.19 [1.04–1.37]), incident dementia (aHR
Diabetes
=1.14 [1.06–1.23]; aHR
Depression
=1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR
Diabetes
=1.18 [1.10–1.26]; aHR
Depression
=1.24 [1.07–1.42]), and all-cause mortality (aHR
Diabetes
=1.29 [1.23–1.36]; aHR
Depression
=1.16 [1.05–1.29]).
Conclusions:
The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.
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Affiliation(s)
- Michael Ouk
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Jessica Colby-Milley
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jiming Fang
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Limei Zhou
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Baiju R. Shah
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
- Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON (B.R.S.)
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Elizabeth Linkewich
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Occupational Science and Occupational Therapy (E.L.), University of Toronto, ON
| | - Marcus Law
- Department of Family and Community Medicine (M.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Richard H. Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Moira K. Kapral
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Bradley J. MacIntosh
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medical Biophysics (B.J.M.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jodi D. Edwards
- University of Ottawa Heart Institute (J.D.E.), University of Ottawa, ON
- School of Epidemiology and Public Health (J.D.E.), University of Ottawa, ON
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
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16
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Widjaja KK, Chulavatnatol S, Suansanae T, Wibowo YI, Sani AF, Islamiyah WR, Nathisuwan S. Knowledge of stroke and medication adherence among patients with recurrent stroke or transient ischemic attack in Indonesia: a multi-center, cross-sectional study. Int J Clin Pharm 2020; 43:666-672. [PMID: 33124676 DOI: 10.1007/s11096-020-01178-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BackgroundThere is a limited data in Indonesia regarding the stroke knowledge and medication adherence among stroke survivors.ObjectiveTo assess the level of stroke knowledge and medication adherence along with their relationship among stroke survivors.SettingTwo tertiary-care hospitals in Surabaya, East Java, Indonesia.MethodsA prospective, cross-sectional study was conducted among 215 stroke survivors. Stroke Knowledge Test and the Morisky Green Levine Adherence Scale questionnaires were used to evaluate stroke knowledge and medication adherence, respectively. Binary logistic regression was performed to assess the rela tionship between stroke knowledge and medication adherence. Main outcome measuresRelationship between stroke knowledge and medication adherence.ResultsA total of 215 patients with mean age of 56.34 ± 8.69 years were recruited into this study. Mean Stroke Knowledge Test score was 7.89 ± 3.38 with 76.7% had low level of stroke knowledge. Mean Morisky Green Levine Adherence Scale was 3.05 ± 1.11 with 52.1% had low to medium medication adherence. Education and duration of stroke correlated with stroke knowledge level (Spearman's correlation coefficient: 0.307, p = 0.001 and 0.128, p = 0.041, respectively). Age and disability correlated with medication adherence (Spearman's correlation coefficient: 0.169; p = 0.013 and 0.171; p = 0.012), respectively. After adjustment for covariates, stroke knowledge level was independently associated with medication adherence (adjusted OR: 4.37, 95% CI 2.00-9.53; p < 0.001).ConclusionStroke knowledge was low among Indonesian stroke survivors and independently related to medication adherence. Attempts should be made to increase stroke knowledge which may improve medication adherence among stroke survivors.
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Affiliation(s)
- Karina Kumaladewi Widjaja
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suvatna Chulavatnatol
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Thanarat Suansanae
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yosi Irawati Wibowo
- Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Achmad Firdaus Sani
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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