Multiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study)

Suboptimal medication possession ratio is associated with recurrent ischemic stroke in a veteran population

OBJECTIVES

Recurrent stroke results in higher disability and mortality but might be mitigated through interventions that improve medication adherence. The medication possession ratio (MPR) is an objective proxy for adherence that may provide an individualized risk assessment for recurrent stroke.

METHODS

This is a retrospective, longitudinal cohort study of patients with recent ischemic stroke or TIA referred to a Veterans Affairs vascular neurology outpatient clinic between 2010 and 2016. We calculated average MPR quartile for four medication classes used for secondary stroke prevention by reviewing pharmacy and medical records following an incident cerebral ischemic event. Traditional stroke risk factors were quantified using the Framingham Stroke Risk Profile (FSRP) score. We hypothesized that lower average MPR would relate to higher recurrent stroke risk more than FSRP or stroke etiological classification.

RESULTS

For 255 patients with stroke or TIA, 57 (22.4 %) patients had recurrent stroke during a median follow-up period of 5.0 years (IQR 2.0). Compared to optimal average MPR, each quartile lower average MPR was associated with higher cumulative incidence of recurrent stroke (subhazard ratio 1.63, 95 %CI: 1.24 to 2.14, p<0.001) while accounting for the competing risk of death and covarying for FSRP. Neither FSRP nor stroke etiology were associated with recurrent stroke. However, higher baseline systolic blood pressure starting at 132 mm Hg was independently associated with stroke recurrence.

CONCLUSIONS

MPR is an effective proxy measurement to assess risk of recurrent stroke. Systems-based and individualized interventions to improve medication adherence are needed to reduce recurrent stroke rates in VA populations.

Large-vessel-occlusion in patients with previous ischemic stroke: an analysis of adherence to secondary preventive medication for different etiologies

BACKGROUND

Large vessel occlusion (LVO) is a severe condition that carries a high risk of morbidity and mortality, underscoring the importance of effective prevention strategies. This retrospective study aimed to analyze the intake of preventive medication at the time of hospitalization in a cohort of recurrent stroke patients presenting with acute LVO.

METHODS

The study assessed the intake of either platelet aggregation inhibitors (PAI), oral anticoagulants (OAC) or statins at admission in patients with recurrent stroke and correlated it with the final classification of LVO. The frequency of those secondary preventive medication in recurrent stroke patients was defined as primary endpoint. The Modified Rankin Scale (mRS) at discharge was used as a functional outcome and defined as a secondary outcome measure.

RESULTS

This study included 866 patients who were treated for LVO between 2016 and 2020, of whom 160 (18.5%) had a recurrent ischemic stroke. OAC (25.6% vs. 14.1%, p < 0.01), PAI (50.0% vs. 26.0%, p < 0.01), or statin therapy (50.6% vs. 20.8%, p < 0.01) at admission were significantly more frequent in recurrent stroke patients compared to patients with a first-time stroke. Concerning LVO etiology in recurrent stroke patients, OAC at admission was taken in 46.8% of cardioembolic LVO, whereas PAI and statin at admission in macroangiopathic LVO were administered to 40.0%; neither PAI nor OAC was taken in 26.0%, 28.3%, and 31.6% of cardioembolic, macroangiopathic, or cryptogenic strokes, respectively. Regardless of stroke recurrence or etiology, there was an increase in mRS at discharge.

CONCLUSIONS

Despite high-quality healthcare, this study suggested a significant proportion of patients with recurrent stroke who were either non-adherent or insufficiently adherent to secondary preventive medication. Given the disability associated with LVO, improving patients' medication adherence and identifying unknown stroke causes are crucial for effective prevention strategies.

[The role of the community and hospital pharmacist in public health prevention in France]

INTRODUCTION

As the healthcare system changes, the pharmacist's place does. In this context the health institutions are looking for improving prevention and so realize how well-placed pharmacists were. For their competences as well as the trust patients are giving, they are serious actors in the implementation of prevention.

METHODS

We sought to understand which place pharmacists take in prevention policies. Thus, we have proceeded with an analysis of bibliography of the past ten years about articles registered in Medline talking about pharmacist's places in French prevention.

RESULTS

We have selected 47 articles classified according to San Marco's 3 levels of prevention: universal, oriented or targeted prevention. The pharmacist is involved in universal prevention, cancer screening or the proper use of antibiotics. In targeted prevention, they are specifically interested in the proper use of medicines and their correct prescription to patients. Finally, for targeted prevention, they offer patients therapeutic education adapted to their needs.

CONCLUSIONS

We can highlight that pharmacists improve consequently the patient's quality of life. They also enhance connections between health care professionals. Thanks to pharmacists, patients can find easy access and reliable health advice and government, trustworthy support for prevention.