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Liu X, Jiang J, Li D, Horrow J, Tamada H, Kahl A, Hariharan V, Avinav A, Li X. Antiplatelet Treatment Patterns and Outcomes for Secondary Stroke Prevention in the United Kingdom. Cardiol Ther 2023; 12:675-687. [PMID: 37789237 DOI: 10.1007/s40119-023-00332-7] [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: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Stroke is a leading cause of death and disability worldwide. Antiplatelet therapies are recommended to reduce the risk of recurrent stroke in patients with ischemic stroke/transient ischemic attack (IS/TIA). This study evaluated outpatient antiplatelet treatment patterns and outcomes for secondary stroke prevention (SSP) among UK adults without atrial fibrillation who were hospitalized for IS/TIA. METHODS This retrospective observational study utilized data from the UK Clinical Practice Research Datalink linked with Hospital Episode Statistics data (01/01/2011-30/06/2019). Treatment patterns included type and duration of treatments. Treatment outcomes included IS, myocardial infarction, major bleeding, and cardiovascular-related and all-cause mortality. Descriptive statistics were reported. RESULTS Of 9270 patients, 13.9% (1292) might not receive antithrombotic therapy within 90 days of hospital discharge. Of 7978 patients who received antiplatelet therapies, most used clopidogrel (74.8%) or aspirin (16.7%) single antiplatelet therapy and clopidogrel + aspirin dual antiplatelet therapy (DAPT, 5.9%). At 1-year post-hospitalization, 36.9, 43.3, and 35.1% of those receiving these treatments discontinued them, respectively, and of the patients initiating DAPT, 62.3% switched to single antiplatelet therapy. At 1-year post-discharge, the incidence rate (per 100 person-years) of IS, myocardial infarction, major bleeding, cardiovascular-related mortality, and all-cause mortality among the treated were 6.5, 0.7, 4.1, 5.0, and 7.3, respectively, and among the untreated were 14.9, 0.7, 8.6, 28.1, and 39.8, respectively. CONCLUSIONS In the United Kingdom, 13.9% of patients hospitalized for stroke might not have any antiplatelet treatment to prevent secondary stroke; among the treated, clopidogrel, aspirin, and DAPT were commonly used. These study findings suggest that improved anti-thrombotic therapies for long-term SSP treatment are needed, which may lead to higher treatment and persistence rates and, therefore, improved outcomes in this population.
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Affiliation(s)
- Xuejun Liu
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | - Jenny Jiang
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | - Danshi Li
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | - Jay Horrow
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | - Hiroshi Tamada
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | - Anja Kahl
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA
| | | | | | - Xiaoyan Li
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08640, USA.
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Dalli LL, Kim J, Thrift AG, Andrew NE, Sanfilippo FM, Lopez D, Grimley R, Lannin NA, Wong L, Lindley RI, Campbell BCV, Anderson CS, Cadilhac DA, Kilkenny MF. Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke. Neurology 2020; 96:e30-e41. [PMID: 33093227 DOI: 10.1212/wnl.0000000000011083] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA. METHODS This is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation. RESULTS Among 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62-0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57-0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77-0.98) were all inversely associated with antihypertensive discontinuation. CONCLUSIONS Patterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
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Affiliation(s)
- Lachlan L Dalli
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Joosup Kim
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Amanda G Thrift
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Nadine E Andrew
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Frank M Sanfilippo
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Derrick Lopez
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Rohan Grimley
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Natasha A Lannin
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Lillian Wong
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Richard I Lindley
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Bruce C V Campbell
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Craig S Anderson
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Dominique A Cadilhac
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China
| | - Monique F Kilkenny
- From Stroke and Ageing Research, Department of Medicine (L.L.D., J.K., A.G.T., R.G., D.A.C., M.F.K.), School of Clinical Sciences at Monash Health, Department of Neuroscience (N.A.L.), and Department of Medicine (N.E.A.), Peninsula Clinical School, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health (J.K., D.A.C., M.F.K.); School of Population and Global Health (F.M.S., D.L.), The University of Western Australia; Sunshine Coast Clinical School, School of Medicine (R.G.), Griffith University; Princess Alexandra Hospital and Metro South Aged Care Assessment Team (L.W.), Metro South Health, Woolloongabba, Queensland; Faculty of Medicine and Health (R.I.L.), The University of Sydney, New South Wales; Department of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria; The George Institute for Global Health (C.S.A), University of New South Wales, Australia; and The George Institute for Global Health at Peking University (C.S.A.), China.
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