Medication adherence and stroke/TIA risk in treated hypertensives: Results from the REGARDS study

Cummings, Doyle M.; Letter, Abraham J.; Howard, George; Howard, Virginia J.; Safford, Monika M.; Prince, Valerie; Muntner, Paul

doi:10.1016/j.jash.2013.05.002

Cited by 29 publications

(25 citation statements)

References 16 publications

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“…Our study is similar to a systematic review of risk factors for intracerebral hemorrhage in the general population that found male sex and hypertension (Ariesen, Claus, Rinkel, & Algra, 2003). Our results are consistent with the previous study showing that medication nonadherence was associated with insufficient blood pressure control and increased risk of incident stroke (Cummings et al, 2013;Hussain, Azad, et al, 2015).…”

Section: Discussionsupporting

confidence: 92%

Predicting risk factors of working aged hemorrhagic stroke patients in a tertiary teaching hospital in Chiang Mai

Triamvisit¹,

Chongruksut²,

Watcharasaksilp³

et al. 2018

Asian/Pacific Island Nursing Journal

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Stroke is the third leading cause of morbidity and mortality in Thailand accounting for a significant and increasing share of hospital costs. The purpose of this project is to study the epidemiology of the prevalence and its predicting factors of working aged hemorrhagic stroke (HS) patients admitted at a tertiary teaching hospital in Chiang Mai, Thailand.We conducted a five-year retrospective descriptive study. The subjects in this study were patients diagnosed with HS, between 15-59 years of age, and admitted to a tertiary teaching hospital in Chiang Mai, Thailand from January 2009 to December 2013. A total of 404 working aged adults who had HS were admitted to the hospital during this review period; 60.9% males and 39.1% females. Nearly 70% of patients were between 46-59 years of age (M = 47.5, SD = 9.8). Of the patients admitted to the hospital, 76.7% were transferred there from other hospitals. Intracerebral hemorrhage was present in 59.7% of patients. Severe HS occurred in 35.9% of the patients with a Glasgow Coma Score from 3-8. Approximately 69% of the working aged HS patients required surgery. The top five identified risk factors for HS were hypertension (83.4%), hyperlipidemia (38.9%), alcohol consumption (21.5%), smoking (15.3 %), and drug non-adherence (14.9%).We found significantly associated risk factors in working-aged HS by multivariate analysis among male gender (p < .001), drug non-adherence (p = .047), and hypertension (p = .048). Raising awareness to reduce risk behavior and health promotion in the community are the keynotes for health care providers in working-aged HS prevention.

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Section: Discussionsupporting

confidence: 92%

Predicting risk factors of working aged hemorrhagic stroke patients in a tertiary teaching hospital in Chiang Mai

Triamvisit¹,

Chongruksut²,

Watcharasaksilp³

et al. 2018

Asian/Pacific Island Nursing Journal

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“…The available data on stroke patients suggest that medication persistence is often sub-optimal, and that many patients are consequently at a significantly increased risk of a further stroke [6,13,16]. Although early initiation of prevention strategies has shown sustained persistence and good outcomes in some stroke patients, other evidence suggests that use of these secondary prevention therapies may not persist long-term [19].…”

Section: Journal Of Neurology and Neuroscience Issn 2171-6625mentioning

confidence: 99%

“…to take prevention medications, there is limited information on medication persistence and the impact on readmission in this population [12,15,16]. We developed a quality improvement program (Transition Coaching for Stroke or TRACS) for patients going home after stroke in order to understand the reasons for readmission.…”

Section: Introductionmentioning

confidence: 99%

Stroke Secondary Medication Persistence and Risk for Hospital Readmission within 90 Days after Discharge

Han¹,

Bushnell

2016

J Neurol Neurosci

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Purpose: In stroke patients, a group at high risk for readmission, there is limited information on medication persistence and its impact on readmission. Utilizing data from a quality improvement program for post-acute processes of care, we investigated the relationship between secondary prevention medication persistence and risk for 90-day readmission in acute stroke patients. Methods:Patients were eligible for the study if they were age 18 years or older and hospitalized with a primary diagnosis of acute ischemic or hemorrhagic stroke, or transient ischemic attack (TIA). A total of 142 patients who had been enrolled in the Transition Coaching for Stroke (TRACS) program were included in the analysis. Results:The mean age was 63.6 ± 13.13 years and 52.8% were women. History of a prior stroke was significantly associated with medication non-persistence (p=0.013, odds ratio [OR], 4.85; 95% confidence interval [CI] 1.39-16.96). History of a prior stroke was also significantly associated with readmission for recurrent stroke or TIA within 30 days of discharge (p= 0.029, OR 7.00; 95% CI 1. 22-40.23). Logistic regression modeling with stroke/TIA readmission at 90 days showed that only prior stroke was significant (p= 0.012, OR 5.54; 95% CI 1.45-21.10). A trend toward lower medication persistence was observed in patients readmitted with a stroke/TIA within 90 days (60.0% vs. 81.8%, p=0.095). Conclusions:In patients discharged with stroke, history of a prior stroke was significantly associated with stroke/TIA readmission at 30 and 90 days after discharge. Poor secondary prevention medication persistence may be a potential risk factor for stroke/TIA readmission. Quality improvement programs focused on improving medication persistence may be essential, especially in patients with a history of recurrent strokes.

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“…Although effective pharmaceutical treatments are readily available and reduce the risk for major cardiovascular diseases,4 inadequate adherence among patients to hypertension medication and the inertia of physicians to intensify treatment contribute to substantial morbidity, mortality, hospitalization, and health care costs 5, 6, 7. Recent studies suggest that treatment intensification improves hypertension management even with suboptimal adherence and reduces risks of cardiovascular events and deaths 8, 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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Medication adherence and stroke/TIA risk in treated hypertensives: Results from the REGARDS study

Cited by 29 publications

References 16 publications

Predicting risk factors of working aged hemorrhagic stroke patients in a tertiary teaching hospital in Chiang Mai

Predicting risk factors of working aged hemorrhagic stroke patients in a tertiary teaching hospital in Chiang Mai

Stroke Secondary Medication Persistence and Risk for Hospital Readmission within 90 Days after Discharge

Treatment Intensification for Hypertension in US Ambulatory Medical Care

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