Use of secondary stroke prevention medicines in Australia: national trends, 2003‐2009

Sluggett, Janet K.; Caughey, Gillian E.; Ward, Michael; Gilbert, Andrew L.

doi:10.5694/mja13.00186

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…Studies have reported long-term changes in the management of stroke risk factors for secondary prevention in North American and Australian populations [ 6 , 7 ]. However, there are no recent data on long-term trends in secondary stroke prevention from Europe and no available reports from countries after the economic transition.…”

Section: Introductionmentioning

confidence: 99%

Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

Bembenek

Karliñski

Kurkowska‐Jastrzębska

et al. 2016

aoms

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IntroductionThe aim of this study was to investigate long-term trends in secondary stroke prevention through management of vascular risk factors directly before hospital admission for recurrent stroke.Material and methodsThis is a retrospective registry-based analysis of consecutive recurrent acute stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke center between 1995 and 2013 with previous ischemic stroke. We compared between four consecutive time periods: 1995–1999, 2000–2004, 2005–2009 and 2010–2013.ResultsDuring the study period, 894 patients with recurrent strokes were admitted (18% of all strokes), including 867 with previous ischemic stroke (our study group). Among those patients, the proportion of recurrent ischemic strokes (88.1% to 93.9%) (p = 0.319) and males (44% to 49.7%) (p = 0.5) remained stable. However, there was a rising trend in patients’ age (median age of 73, 74, 76 and 77 years, respectively). There was also an increase in the use of antihypertensives (from 70.2% to 83.8%) (p = 0.013), vitamin K antagonists (from 4.8% to 15.6%) (p = 0.012) and statins (from 32.5% to 59.4%) (p < 0.001). Nonetheless, 21% of patients did not receive any antithrombotic prophylaxis. Tobacco smoking pattern remained unchanged.ConclusionsOur data indicate a clear overall improvement of secondary stroke prevention. However, persistent use of antithrombotic drugs and tobacco smoking after the first ischemic stroke is constantly suboptimal.

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Section: Introductionmentioning

confidence: 99%

Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

Bembenek

Karliñski

Kurkowska‐Jastrzębska

et al. 2016

aoms

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“…Separations indicating either inter- or intra-hospital transfers, a change in the type of care provided (for example, from acute to sub-acute care), death or discharge to home or other accommodation, were linked to form a continuous period of hospitalisation. As previously described, 8 contiguous episodes were joined if separated by up to 24 hours 17 or if recorded by the end of the next day if the preceding separation was recorded at another hospital.…”

Section: Methodsmentioning

confidence: 99%

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Gattellari

Goumas

Jalaludin

et al. 2020

Preprint

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Background: Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery. Methods: We calculated admissions rates for ischaemic stroke, intracerebral haemorrhage or subarachnoid haemorrhage between January 1, 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to December 31st 2014 for patients aged 15 years or older from New South Wales, Australia (population 7.99 million). Annual Average Percentage Change in rates was estimated using negative binomial regression. Results: Of 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval=-3.5% to -0.9%) (p<0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change -2.9%, 95% Confidence Interval=-5.2% to -1.0%) (p=0.004) and subarachnoid haemorrhage (Average Percentage Change=-2.6%, 95% Confidence Interval=-4.8% to -0.2%) (p=0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in 30-day survivors of subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval=-0.1% to 12.8%), although the increase was not statistically significant (p=0.05). Conclusion: Improved prevention may have underpinned declining intracerebral haemorrhage rates while gains in survival suggest that innovations in stroke care are being successfully translated. Longer-term mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.

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“…A commonly used metric is to calculate the time taken for patients to refill scripts and estimate dosages by the application of the 75th percentile of refill times for each patient (PDD 75 ) 13–20 . However, as shown in a recent study that included a measure of the PDD based on the 80th percentile of the time taken until the next refill of various antihypertensive classes in patients with heart failure, 21 there may be substantial differences between PDC and 1DD estimates.…”

Section: Introductionmentioning

confidence: 99%

Assuming one dose per day yields a similar estimate of medication adherence in patients with stroke: An exploratory analysis using linked registry data

Ung

Dalli

Lopez

et al. 2020

Brit J Clinical Pharma

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Purpose Prescribed daily dose (PDD), the number of doses prescribed to be taken per day, is used to calculate medication adherence using pharmacy claims data. PDD can be substituted by (i) one dose per day (1DD), (ii) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD75) or (iii) the World Health Organization's defined daily dose (DDD). We aimed to compare these approaches for estimating the duration covered by medications and whether this affects calculated 1‐year adherence to antihypertensive medications post‐stroke. Methods We conducted a retrospective review of prospective cohort data from the ongoing Australian Stroke Clinical Registry linked with pharmacy claims data. Adherence was calculated as the proportion of days covered (PDC) for 1DD, PDD75 and DDD. Differences were assessed using Wilcoxon rank‐sum tests. Results Among 12 628 eligible patients with stroke, 10 057 (80%) were prescribed antihypertensive medications in the year after hospital discharge (78.2% aged ≥65 years, 45.2% female). Overall, the 75th percentile of patient time until next medication refill was 39 days. The greatest variations in dose regimens, estimated using person‐ and dose‐level refill times, were for beta blockers (11.4% taking two tablets/day). There were comparable levels of adherence between 1DD and the PDD75 (median PDC 91.0% vs 91.2%; P = 0.70), but adherence was slightly higher using DDD (92.3%; both P < 0.001). However, this would represent a clinically nonsignificant difference. Conclusion Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.

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Use of secondary stroke prevention medicines in Australia: national trends, 2003‐2009

Cited by 9 publications

References 15 publications

Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

Changes in pre-hospital management of vascular risk factors among patients admitted due to recurrent stroke in Poland from 1995 to 2013

Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

Assuming one dose per day yields a similar estimate of medication adherence in patients with stroke: An exploratory analysis using linked registry data

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