Background And Aims Prescription of multiple classes of medications (antihypertensive, antithrombotic and lipid-lowering) is recommended in clinical guidelines for ischemic stroke (IS) and transient ischemic attack (TIA) to prevent further vascular events. We aimed to determine the association between optimal combination medication treatment (supply of all three classes, “optimal treatment”) and survival after IS/TIA.

Methods Cohort of patients with first-ever IS/TIA from the Australian Stroke Clinical Registry (2010–2014) linked with pharmaceutical claims data. We excluded patients who died within 30 days of admission. Cox regression was used to determine associations between optimal treatment and 1-year (from day 30 to 395) survival using landmark methods, adjusting for socio-demographics (age, sex, socioeconomic position) and clinical characteristics (stroke type, discharge destination).

Results Among 8136 survivors with first-ever IS/TIA satisfying inclusion criteria (45% female, median age 74 years), 75.5% received ≥1 medication class, and 34.0% had optimal treatment. Patients with optimal treatment (N = 2765) were more often aged ≥75 years (51.3% vs 44.3%; p < 0.001), discharged directly home (65.8% vs 49.5%; p < 0.001) and experienced a less severe stroke (53.2% vs 43.5%; p < 0.001), than those without optimal treatment. Compared to no medication, treatment with two medications was associated with a 42% lesser risk of death (95%CI: 27–55%); and optimal treatment, a 68% lesser risk of death (95% CI: 49–65%). Survival was similar between those with one or no medication.

Conclusions Patients with stroke/TIA who received optimal combination medication treatment within 30-days of admission had greater one-year-survival. Further research is required to understand reasons for sub-optimal medication treatment.