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dc.contributor.authorDalli, Lachlan L
dc.contributor.authorKim, Joosup
dc.contributor.authorThrift, Amanda G
dc.contributor.authorAndrew, Nadine E
dc.contributor.authorSanfilippo, Frank M
dc.contributor.authorLopez, Derrick
dc.contributor.authorGrimley, Rohan
dc.contributor.authorLannin, Natasha A
dc.contributor.authorWong, Lillian
dc.contributor.authorLindley, Richard I
dc.contributor.authorCampbell, Bruce CV
dc.contributor.authorAnderson, Craig S
dc.contributor.authorCadilhac, Dominique A
dc.contributor.authorKilkenny, Monique F
dc.contributor.authorAuSCR Consortium
dc.date.accessioned2020-10-26T03:05:10Z
dc.date.available2020-10-26T03:05:10Z
dc.date.issued2020
dc.identifier.issn0028-3878
dc.identifier.doi10.1212/WNL.0000000000011083
dc.identifier.urihttp://hdl.handle.net/10072/398676
dc.description.abstractOBJECTIVE: To investigate whether certain patient, acute-care, or primary-care factors are associated with medication initiation and discontinuation in the community post-stroke or TIA. METHODS: 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 post-discharge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year post-discharge. 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 post-discharge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub-hazard ratio [SHR]: 0.70; 95% 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 one-year post-discharge. Improving post-discharge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.relation.ispartofjournalNeurology
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchNeurosciences
dc.subject.fieldofresearchCognitive Sciences
dc.subject.fieldofresearchcode1103
dc.subject.fieldofresearchcode1109
dc.subject.fieldofresearchcode1702
dc.titlePatterns of use and discontinuation of secondary prevention medications after stroke
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationDalli, 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; AuSCR Consortium, , Patterns of use and discontinuation of secondary prevention medications after stroke., Neurology, 2020
dcterms.dateAccepted2020-08-12
dc.date.updated2020-10-26T00:06:37Z
gro.description.notepublicThis publication has been entered as an advanced online version in Griffith Research Online.
gro.hasfulltextNo Full Text
gro.griffith.authorGrimley, Rohan
gro.griffith.authorWong, Lillian


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