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HUNG STANLEYHUGHWA, KHLIF MOHAMEDSALAH, KRAMER SHARON, WERDEN EMILIO, BIRD LAURAJ, CAMPBELL BRUCECV, BRODTMANN AMY. Poststroke White Matter Hyperintensities and Physical Activity: A CANVAS Study Exploratory Analysis. Med Sci Sports Exerc 2022; 54:1401-1409. [DOI: 10.1249/mss.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yi X, Chen H, Yu M, Luo H, Zhou J, Wei W, Wang Y, Chen X. Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population. Front Neurol 2022; 13:925061. [PMID: 35959409 PMCID: PMC9358006 DOI: 10.3389/fneur.2022.925061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Hong Chen
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
- *Correspondence: Hong Chen
| | - Ming Yu
- Department of Neurology, Suining Central Hospital, Suining, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yanfen Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Xiaorong Chen
- Department of Neurology, Suining Central Hospital, Suining, China
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Qin H, Turnbull I, Chen Y, Wright N, Liu L, Pei P, Tang W, Xiang S, Guo Y, Zhao X, Clarke R, Li L, Wang Y, Chen Z. Hospital management of major stroke types in Chinese adults: a population-based study of 20 000 hospitalised stroke cases. BMJ Open 2021; 11:e054265. [PMID: 34785558 PMCID: PMC8596044 DOI: 10.1136/bmjopen-2021-054265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare hospital treatments for major stroke types in Chinese adults by stroke pathological types, sex, age, calendar year, hospital tier, region and other factors. DESIGN Cross-sectional analysis of medical records retrieved from 20 229 stroke cases in the China Kadoorie Biobank. SETTING Ten diverse areas (five urban, five rural) in China. PARTICIPANTS First-incident stroke cases who were recruited during an 11-year follow-up of 0.5M participants in the China Kadoorie Biobank. METHODS Electronic copies of medical records of stroke cases were retrieved for clinical adjudication by local neurologists. Stroke cases were classified as ischaemic stroke (IS) (including lacunar infarction (LACI) and non-LACI (non-LACI)), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) and unspecified stroke types. RESULTS Among 20 299 first-ever stroke cases, 17 306 (85%) had IS, 7123 had non-LACI, 6690 had LACI, 3493 had silent LACI, 2623 (13%) had ICH and 370 (2%) had SAH. Among IS cases, antiplatelet treatment was used by 64% (65% non-LACI, 66% LACI, 56% silent LACI), lipid-lowering by 50% (52% non-LACI, 53% LACI, 43% silent LACI) and blood pressure-lowering by ~42% of all IS types, with positive trends in the use of these treatments by calendar year and hospital tier. Among ICH cases, 53% used blood pressure-lowering and 10% used lipid-lowering treatments, respectively. In contrast, traditional Chinese medicines (TCMs) were used by 59% of IS (50% non-LACI, 62% LACI, 74% silent LACI), 38% of ICH and 30% of SAH cases, with positive trends by calendar year and by hospital tier. CONCLUSIONS Among IS cases, use of antiplatelet and lipid-lowering medications increased in recent years, but use of TCM still exceeded use of blood pressure-lowering treatment. In contrast, blood pressure-lowering treatment was widely used for ICH, but only half of all ICH cases used blood pressure-lowering treatment.
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Affiliation(s)
- Haiqiang Qin
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liping Liu
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Wei Tang
- Emergency Department, Pengzhou Traditional Chinese Medical Hospital, Sichuan, China
| | | | - Yu Guo
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
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Sadeghi Hokmabadi E, Shams Vahdati S, Alizadeh Najmi E. Ischemic stroke as the initial manifestation of atrial fibrillation; is it higher than expected? J Cardiovasc Thorac Res 2021; 13:263-264. [PMID: 34630977 PMCID: PMC8493230 DOI: 10.34172/jcvtr.2021.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/19/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elyar Sadeghi Hokmabadi
- Neurosciences Research Center, Department of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Shams Vahdati
- Emergency Medicine Research Team, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elyar Alizadeh Najmi
- Neurosciences Research Center, Department of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Rates, Predictors, and Impact of Smoking Cessation after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 30:106012. [PMID: 34330020 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smoking cessation after a first cardiovascular event reduces the risk of recurrent vascular events and mortality. This systematic review and meta-analysis aimed to summarize data on the rates, predictors, and the impact of smoking cessation in patients after a stroke or transient ischemic attack (TIA). METHODS MEDLINE, EMBASE and Web of Science were searched to identify all published studies providing relevant data through May 20, 2021. Random-effects meta-analysis method was used to pool proportions. Some findings were summarized narratively. RESULTS Twenty-five studies were included. The pooled smoking cessation rates were 51.0% (8 studies, n = 1738) at 3 months, 44.4% (7 studies, n = 1920) at 6 months, 43.7% (12 studies, n = 1604) at 12 months, and 49.8% (8 studies, n = 2549) at 24 months or more of follow-up. Increased disability and intensive smoking cessation support programs were associated with a higher likelihood of smoking cessation, whereas alcohol consumption and depression had an inverse effect. Two studies showed that patients who quit smoking after a stroke or a TIA had substantially lower risk of recurrent stroke, death, and a composite of stroke, myocardial infarction, and death. CONCLUSION Smoking cessation in stroke survivors is associated with reduced recurrent vascular events and death. About half of smokers who experience a stroke or a TIA stop smoking afterwards. Those with low post-stroke disability, who consume alcohol, or have depression are less likely to quit. Intensive support programs can increase the likelihood of smoking cessation.
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Srithumsuk W, Chaleoykitti S, Jaipong S, Pattayakorn P, Podimuang K. Association between depression and medication adherence in stroke survivor older adults. Jpn J Nurs Sci 2021; 18:e12434. [PMID: 34137175 DOI: 10.1111/jjns.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/29/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to investigate the association between depression score and medication adherence in stroke survivor older adults. METHODS The participants were 102 stroke survivor older adults. The outcome was medication adherence during a 6-month follow-up. The independent variable was the depression score which was assessed by the Patient Health Questionnaire-9 (PHQ-9). The confounding factors included sociodemographic data, clinical characteristics, number of comorbidities, and number of medications. We analyzed the association between depression and medication adherence using multiple linear regression analyses. RESULTS The PHQ-9 score of stroke survivor older adults at the baseline was 1.11±2.03, and at the 6-month follow-up was increased to 5.06±3.91. The medication adherence mean score at the outcome was 4.15±1.83. After full adjustment, the PHQ-9 scores at baseline and 6-month follow-up were significantly associated with medication adherence (β = -.315, 95% CI = -.483 to -.086, p = 0.006 and β = -.270, 95% CI = -.238 to -.020, p = 0.021, respectively). Other variables that affect medication adherence during a 6-month follow-up included living with others and a lower number of medications. CONCLUSION This study revealed that lower depression scores were associated with high medication adherence in post-stroke older adults. Additionally, living with others and a lower number of medications were associated with medication adherence. Therefore, stroke survivor older adults should be assessed for depression and given medication, and education should be used to improve mediation adherence, especially for the ones who live alone and have polypharmacy to prevent recurrent stroke.
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Affiliation(s)
- Werayuth Srithumsuk
- Faculty of Nursing Science and Allied Health, Phetchaburi Rajabhat University, Phetchaburi, Thailand
| | | | - Saitip Jaipong
- Stroke Unit, Phrachomklao Hospital, Phetchaburi, Thailand
| | - Pinthusorn Pattayakorn
- Department of Nursing, College of Natural Science, California State University San Bernardino, San Bernardino, California, USA.,Stroke Unit, Eisenhower Health, Rancho Mirage, California, USA
| | - Kattiya Podimuang
- Annenberg 3 South Telemetry Unit, Eisenhower Medical Center, Rancho Mirage, California, USA
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Shani SD, Sylaja PN, Sankara Sarma P, Raman Kutty V. Facilitators and barriers to medication adherence among stroke survivors in India. J Clin Neurosci 2021; 88:185-190. [PMID: 33992182 DOI: 10.1016/j.jocn.2021.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/21/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Strict compliance with medication and life style modification are integral to secondary stroke prevention. This study was undertaken to find out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defined as consumption at least >80% of their medications for last two weeks, based on last prescription. Structured interview using pretested interview schedule was done to collect other data. Sequential step wise logistic regression analysis was done to find out the facilitators and barriers to medication adherence. Two hundred and forty stroke survivors (mean age 58.64 ± 10.96 years; 25.4% females) with a mean post-stroke period of 6.65 ± 3.36 months were participated. Overall medication adherence was 43.8% (n = 105). Medication adherence was 34.3% (n = 134), 52.6% (n = 190) and 56.7% (n = 224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio (OR) = 4.85; 95% Confidence Interval (CI) 2.12-11.08, Hypertension: OR = 3.42; 95% CI 1.83-6.4, Dyslipidaemia: OR = 3.88; 95% CI 1.96-4.04). Having daily routine (OR = 2.82; 95% CI 1.52-5.25), perceived need of medication (OR = 2.33; 95% CI 1.04-5.2) and perceived poor state of health (OR = 2.65; 95% CI 1.30-5.40) were facilitators. Memory issues (OR = 0.34; 95% CI 0.16-0.71), side effects (OR = 0.24; 95% CI 0.11-0.42) and financial constraints (OR = 0.46; 95% CI 0.24-0.91) were barriers to medication adherence. Establishing daily routines, periodic reminders, financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.
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Affiliation(s)
- S D Shani
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala 695 011, India.
| | - P Sankara Sarma
- Achutha Menon Centre for Health Sciences Studies (AMCHSS), Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - V Raman Kutty
- Research Director, Amala Cancer Research Centre, Thrissur 680555, India
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Medication adherence for secondary stroke prevention and its barriers among lebanese survivors: A cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ademuyiwa I, Okubadejo N. Effect of a nurse-led secondary stroke prevention intervention on medium-term stroke outcome in a teaching hospital in Nigeria: A quasi-experimental study. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Determinants of preventable stroke-Ankara ACROSS stroke preventability study. J Stroke Cerebrovasc Dis 2020; 29:104825. [PMID: 32362556 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle and inadequate control of vascular risk factors are the major contributors of stroke burden. Failure in achieving the target levels in control of these factors, not only designate missed opportunities contributing to the preventability of an incident stroke, but also set the post-stroke treatment goals in a case wise basis. In this study, we analyzed pre-event clinical features that play a role in stroke preventability, and determined the cumulative burden of risk factors that necessitate optimization following the ischemic insult. METHODS Information about the pre-stroke optimal control of seven major modifiable risk factors (Life's Simple 7: hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, diet, and physical activity) was prospectively collected in ischemic stroke patients admitted to three tertiary academic centers in Ankara. Stroke preventability was evaluated by the overall number of factors requiring optimization with patients ≥4 risk factor conditions categorized as those suffering from a preventable stroke. Bivariate and multivariate analyzes were performed to uncover predictors of stroke preventability. RESULTS Among 787 patients, 386 (49.0%) had ≥4 risk factor conditions requiring optimization. Preventable stroke was more common in younger patients, and patients with small artery occlusion. Multivariate analyses taking into account the pre-stroke antithrombotic treatment regimen, have highlighted age (OR: 0.99, 95%CI 0.98-1.00), female gender (1.59, 95%CI 1.17-2.16), coronary artery disease (1.54, 95%CI 1.10-2.14), small artery occlusion (1.90, 95%CI 1.13-3.18), and cardio-aortic embolism (0.53, 95%CI 0.35-0.82) as significant factors associated with preventability. CONCLUSIONS Approximately half of the ischemic stroke patients have preventable stroke from the perspective of risk factor control. Extra care should be given to strategies directed to risk factor control and lifestyle interventions in certain high-risk groups for the prevention of future complications.
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Zhang Y, Fan D, Ji H, Qiao S, Li X. Treatment Adherence and Secondary Prevention of Ischemic Stroke Among Discharged Patients Using Mobile Phone- and WeChat-Based Improvement Services: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e16496. [PMID: 32293574 PMCID: PMC7190093 DOI: 10.2196/16496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/08/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Real-world studies have indicated that adherence is important for guaranteeing medication effectiveness. Few studies have tested the feasibility and efficacy of WeChat-based improvement services, via mobile phone, in secondary prevention-specific follow-up among discharged stroke patients. OBJECTIVE We evaluated a quadruple-domain, WeChat-based service for ischemic stroke secondary prevention designed to improve treatment adherence of discharged patients. This service focuses on sending reminders for drug use, blood pressure recording, and glucose recording; it also records medication use. We compared the endpoint event rate between WeChat self-monitoring and traditional monitoring. METHODS A cohort study was used to determine the feasibility of a physician-assisted, WeChat-based improvement service and follow-up self-monitoring platform for the secondary prevention of ischemic stroke. The platform was developed by the Peking University Third Hospital based on the information-motivation-behavioral skills model. The overall adherence rate was calculated as the proportion of medication doses verified via uploading. The ischemic endpoint event rate and medication noncompliance rate were compared between traditional prevention monitoring and WeChat self-monitoring. Factors influencing adherence were summarized. RESULTS The 1-year follow-up event rate of the WeChat self-monitoring group was 11.9% (12/101), which was less than that of the traditional group (21/157, 13.4%). Compared with the traditional group, the risk ratio of the WeChat group was 0.983 (95% CI 0.895-1.080); this difference was not noted to be significant. The 1-year medication noncompliance ratio tended to be lower in the WeChat monitoring group (3/101, 3.0%) than in the traditional group (11/157, 7.0%; χ2=1.9, df=1, P=.16). Of the platform registry participants, 89.7% (210/234: 167 hospital-based and 43 community-based participants) adhered to inputting information into WeChat for 8-96 weeks. The average adherence time was 16.54 (SD 0.80, range 2-24) months. The average decrease in adherence was 4 participants (1.1%) per month. Being a member of a community-based population was an influencing factor for good adherence at the 2-year follow-up (OR 2.373, 95% CI 1.019-5.527, P=.045), whereas transient ischemic attack was an influencing factor for poor adherence at the 2-year follow-up (OR 0.122, 95% CI 0.016-0.940, P=.04). CONCLUSIONS Use of WeChat self-monitoring showed a trend of increasing medication compliance and decreasing ischemic endpoint event rate compared with traditional monitoring. However, there were ceiling effects in the outcomes, and a relatively small sample size was used. Male participants displayed better adherence to WeChat self-monitoring. The community-based population displayed good adherence when using WeChat self-monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT02618265; https://clinicaltrials.gov/ct2/show/NCT02618265.
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Affiliation(s)
- Yuanjin Zhang
- Neurology Department, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Neurology Department, Peking University Third Hospital, Beijing, China
| | - Hong Ji
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Shudong Qiao
- Neurology Department, Peking University Shougang Hospital, Beijing, China
| | - Xia Li
- Neurology Department, Peking University Shougang Hospital, Beijing, China
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Use of a Discharge Educational Strategy Versus Standard Discharge Care on Reduction of Vascular Risk in Patients with Stroke and Transient Ischemic Attack. Curr Cardiol Rep 2020; 22:27. [PMID: 32193624 DOI: 10.1007/s11886-020-01283-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF THE REVIEW The burden of ischemic stroke is disproportionally distributed between ethnic and racial subgroups in the USA, minority populations with lower socioeconomic status being at higher risk. These discrepancies are mirrored in susceptibility, primary care, and post-discharge procedures. Post-discharge strategies are of particular importance as their primary goal is to prevent recurrent stroke, which makes up about 25% of stroke cases per year in US. As disadvantaged minorities have faster growing populations, recurrent stroke poses a significant challenge not only for caretakers but also for the health care system as the whole. A number of educational strategies were employed to inform the general public of major symptoms, risk factors, and preventive measures for recurrent stroke. However, over affected subgroups did not prove responsive to such measures as these did not conform to their cultural and sociological specificities. RECENT FINDINGS The Discharge Educational Strategies for Reduction of Vascular Events Intervention (DESERVE) is a randomized control trial with a one year follow up, set out to investigate the possibility that culturally tailored, community-centered post-discharge strategies would improve compliance to therapy and prevention against secondary stroke. The trial targeted African Americans, Hispanic, and non-Hispanic whites, adapting discharge strategies for each individual group. DESERVE accomplished a significant reduction in blood pressure in the Hispanic intervention group by 9.9 mm Hg compared with usual care. The remaining two groups were not susceptible to these measures. DESERVE holds promise for culturally tailored interventions in the future in a battle against stroke and other chronic diseases.
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Cheiloudaki E, Alexopoulos EC. Adherence to Treatment in Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020196. [PMID: 30641978 PMCID: PMC6351941 DOI: 10.3390/ijerph16020196] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
Abstract
Background: Compliance with medication in patients who have suffered stroke is usually not-optimal. This study aims to measure the level of compliance with the treatment and to identify socio-demographic, clinical, and subjective factors related to the long-term compliance of stroke patients with their treatment. Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six months old, participated in the survey. Compliance was measured using the Medication Adherence Report Scale and the quality of life by the Stroke Specific Quality of Life questionnaire. Furthermore, the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire on perceptions about the disease were assessed. The doctor–patient relationship was assessed by the Common-Sense Model of Self-Regulation questionnaire and the family support was assessed by the FSS scale. Univariate and multivariate analysis was employed to identify the significant factors affecting compliance in these stroke patients. Results: In 68.6% of patients the compliance was classified as optimal, in 25.7% as partial and as poor in 5.7%; the last two categories were treated as sub-optimal compliance in multivariate analysis. The high compliance was related to patient’s mental state (OR:3.94 95% CI: 1.84–4.46), the perception medication necessity (OR:1.26 95% CI: 1.01–1.56), and the doctor–patient communication (OR:1.76 95% CI: 1.15–2.70). Men showed a lower compliance than women, as well as increased concerns about taking medication (OR: 0.83, 95% CI: 0.69–0.99). Paradoxically, the work /productivity related quality of life was inversely associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The perception of medication necessity and the doctor–patient communication are manageable factors associated with compliance in treating patients who have suffered stroke. In addition, rehabilitation and return to work programs should consider these factors when providing support to those persons.
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Affiliation(s)
| | - Evangelos C Alexopoulos
- School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
- Occupational Health Department, Metropolitan General Hospital, 15562 Athens, Greece.
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Improving medication adherence in stroke survivors: the intervention development process. BMC Health Serv Res 2018; 18:772. [PMID: 30309346 PMCID: PMC6182841 DOI: 10.1186/s12913-018-3572-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. A lack of underlying theory may contribute to the ineffectiveness of eliciting or sustaining behaviour change in many existing interventions targeting medication adherence in stroke. Intervention effectiveness and implementation could be enhanced by consideration of evidence base and theory to drive development. The purpose of this study is to identify appropriate components for a theory-driven and evidence-based medication adherence intervention for stroke survivors. Methods The Behaviour Change Wheel (BCW), a guide to intervention development, informed our systematic process of intervention development. Our earlier systematic review had identified important determinants of medication adherence that were mapped into the Theoretical Domains Framework (TDF), with Knowledge, Beliefs about consequences and Emotions found to be more influential. Utilising the BCW facilitated selection of intervention options and behaviour change techniques (BCTs); the active ingredients within an intervention. To further refine BCT selection, APEASE criteria were employed, allowing evaluation of potential BCTs within context: The National Health Service (NHS), United Kingdom (UK). Results Five intervention functions (Education, Persuasion, Training, Environmental Restructuring and Enablement) and five policy categories (Communication/marketing, Guidelines, Regulation, Environmental/social planning and Service provision) were identified as potential intervention options, underpinned by our systematic review findings. Application of APEASE criteria led to an initial pool of 21 BCTs being reduced to 11 (e.g. Habit Formation, Information about Health Consequences and Action Planning) identified as potential intervention components that would both be feasible and directly target the underlying determinants of stroke survivors’ medication adherence. Conclusions Careful consideration of underlying evidence and theory to drive intervention design, facilitated by the BCW, enabled identification of appropriate intervention components. BCTs including Habit Formation, Information about Health Consequences and Self-monitoring of Behaviour were considered potentially effective and appropriate to deliver within the NHS. Having reduced the pool of potential intervention components to a manageable number, it will now be possible to explore the perceived acceptability of selected BCTs in interviews with stroke survivors and healthcare professionals. This approach to intervention development should be generalisable to other chronic conditions and areas of behaviour change (e.g. exercise adherence).
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Wang MD, Wang Y, Mao L, Xia YP, He QW, Lu ZX, Yin XX, Hu B. Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study. Trop Med Int Health 2018; 23:1200-1206. [PMID: 30178470 DOI: 10.1111/tmi.13148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES A good mastery of stroke-related knowledge can be of great benefit in developing healthy behaviours. This study surveyed the knowledge about stroke and influencing factors among patients with acute ischaemic stroke (AIS) at discharge in a Chinese province. METHODS A cross-section study was conducted from November 1, 2014 to January 31, 2015. A total of 1531 AIS patients in Hubei Province completed a questionnaire at discharge. Multivariate linear regression was used to identify the influencing factors of their knowledge of stroke. RESULTS About 31.2% of the respondents did not know that stroke is caused by blockage or rupture of cerebral blood vessels and 20.3% did not realise they need immediate medical attention after onset. Approximately 50% did not know that sudden blurred vision, dizziness, headache and unconsciousness are the warning signs of stroke. Over 40% were not aware of the risk factors of the condition, such as hypertension, hyperlipidaemia, diabetes mellitus, smoking and obesity. Over 20% had no idea that they need long-term medication and strict control of blood pressure, blood lipids and blood sugar. Their knowledge levels were correlated with regions of residence (P < 0.0001), socioeconomic status (P < 0.05), physical condition (P < 0.01), previous stroke (P < 0.0001) and family members and friends having had a stroke (P < 0.01). CONCLUSIONS Most AIS patients in Hubei Province, China, had little knowledge of stroke at discharge. Further efforts should be devoted to strengthening the in-hospital education of stroke patients, especially those with a low income and those from rural areas.
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Affiliation(s)
- Meng-Die Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuan-Peng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Quan-Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zu-Xun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Xv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,The Stroke Quality Control Center of Hubei Province, Wuhan, China
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17
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Crayton E, Fahey M, Ashworth M, Besser SJ, Weinman J, Wright AJ. Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies. Ann Behav Med 2018; 51:833-845. [PMID: 28421453 PMCID: PMC5636868 DOI: 10.1007/s12160-017-9906-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. PURPOSE The aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence. METHODS In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF. RESULTS Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations. CONCLUSIONS This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.
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Affiliation(s)
- Elise Crayton
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Marion Fahey
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Sarah Jane Besser
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - John Weinman
- King's College London, Institute of Pharmaceutical Sciences, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
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18
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Mechtouff L, Haesebaert J, Viprey M, Tainturier V, Termoz A, Porthault-Chatard S, David JS, Derex L, Nighoghossian N, Schott AM. Secondary Prevention Three and Six Years after Stroke Using the French National Insurance Healthcare System Database. Eur Neurol 2018; 79:272-280. [PMID: 29758555 DOI: 10.1159/000488450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Secondary prevention is inadequate in the first 2 years after stroke but what happens after that is less documented. The aim of this study was to assess the use and the adherence to preventive drugs 3 and 6 years after experiencing a transient ischemic attack (TIA) or an ischemic stroke (IS). METHODS The population study was from the AVC69 cohort (IS or TIA admitted in an emergency or stroke unit in the Rhône area, France, for an IS or a TIA during a 7-month period). Medication use was defined as ≥1 purchase during the studied year and adherence as Continuous Measure of Medication Acquisition ≥0.8 using the French medical insurance health care funding database. RESULTS The study population consisted of 210 patients at 3 years and 163 patients at 6 years. Medication use at 3 and 6 years was, respectively, 80.9 and 79.8% for antithrombotics, 69.1 and 66.3% for antihypertensives, 60.5 and 55.2% for statins and 48.6 and 46.6% for optimal treatment defined as the treatment achieved by the use of the 3 drugs. Adherence to each class was good at 3 years and tends to decrease at 6 years. CONCLUSIONS More than one patient out of 2 do not use the optimal preventive treatment.
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Affiliation(s)
- Laura Mechtouff
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France
| | - Julie Haesebaert
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Viprey
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Tainturier
- Département de Recherche et d'Informations Médicalisées (DRIM), Direction Régionale du Service Médical de Rhône-Alpes (DRSM RA), Lyon, France
| | - Anne Termoz
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Jean-Stéphane David
- Service d'Anesthésie-Réanimation-Urgence, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France
| | - Norbert Nighoghossian
- Stroke Unit, Hôpital Pierre Wertheimer, Hospices Civils de, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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19
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Sarfo FS, Kyem G, Ovbiagele B, Akassi J, Sarfo-Kantanka O, Agyei M, Badu E, Adusei Mensah N. One-Year Rates and Determinants of Poststroke Systolic Blood Pressure Control among Ghanaians. J Stroke Cerebrovasc Dis 2017; 26:78-86. [PMID: 27639589 PMCID: PMC6402574 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Elevated systolic blood pressure (SBP) is potently associated with risk of recurrent strokes. In resource-limited settings, there is a dearth of data on the rates and determinants of uncontrolled SBP among stroke survivors at high risk of recurrent events. The objective of this study is to assess the rates and determinants of uncontrolled SBP over the first year post stroke. METHODS This is a retrospective observational study involving stroke survivors who enrolled into an outpatient neurology clinic in Kumasi, Ghana, between January 2012 and June 2014. Baseline demographic features, clinical characteristics, antihypertensive medications prescribed at each clinic visit, treatment modifications, and clinic blood pressure measurements were recorded. Predictors of uncontrolled SBP during follow-up were assessed using a multivariable logistic regression model. RESULTS A total of 602 stroke survivors enrolled for follow-up within the study period of which 89.8% had hypertension. Up to 35% of subjects had an SBP above 140 mmHg during follow-up clinic visits. Among those with uncontrolled SBP, 17% had antihypertensive treatment modifications during follow-up. Predictors of uncontrolled SBP were SBP at enrollment into clinic, with an adjusted odds ratio (OR [95% confidence interval {CI}]) of 1.31 (1.17-1.47)/10 mmHg increase, and average number of antihypertensive medications prescribed, with an adjusted OR (95% CI) of 1.30 (1.06-1.60) for an increase in the number of antihypertensives prescribed. CONCLUSION A third of stroke survivors had SBP not on target during follow-up possibly due to a combination of therapeutic inertia, apparent treatment resistance, and poor adherence to therapy. Longer-term prospective interventional studies on hypertension control among stroke survivors are warranted in sub-Saharan Africa.
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Affiliation(s)
- Fred Stephen Sarfo
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
| | - Gloria Kyem
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Bruce Ovbiagele
- Neurology Department, Medical University of South Carolina, Charleston, South Carolina
| | - John Akassi
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Osei Sarfo-Kantanka
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Martin Agyei
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Elizabeth Badu
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Nathaniel Adusei Mensah
- Division of Neurology, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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20
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Al-Jazaeri A. The response pattern and adherence to oral propranolol among Saudi children treated for infantile hemangioma. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [DOI: 10.1016/j.jdds.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Björck F, Ek A, Johansson L, Själander A. Warfarin persistence among atrial fibrillation patients - why is treatment ended? Cardiovasc Ther 2016; 34:468-474. [DOI: 10.1111/1755-5922.12224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fredrik Björck
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Agnes Ek
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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22
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Lee MJ, Park E, Kim HC, Lee HS, Cha MJ, Kim YD, Heo JH, Nam HS. Timely Interventions can Increase Smoking Cessation Rate in Men with Ischemic Stroke. J Korean Acad Nurs 2016; 46:610-7. [PMID: 27615050 DOI: 10.4040/jkan.2016.46.4.610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/11/2016] [Accepted: 05/18/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE Smoking cessation is strongly recommended for every smoker after ischemic stroke, but many patients fail to quit smoking. An improved smoking cessation rate has been reported with intensive behavioral therapy during hospitalization and supportive contact after discharge. The aim of this study was to demonstrate the usefulness of the timely interventions for smoking cessation in men with acute ischemic stroke. METHODS Patients who participated in the timely interventions strategy (TI group) were compared with those who received conventional counseling (CC group). In the TI group, a certified nurse provided comprehensive education during admission and additional counseling after discharge. Outcome was measured by point smoking success rate and sustained smoking cessation rate for 12 months. RESULTS Participants, 157 men (86 of the TI group and 71 of the CC group), were enrolled. Mean age was 58.25 ± 11.23 years and mean initial National Institutes of Health Stroke Scale score was 4.68 ± 5.46. The TI group showed a higher point smoking success rate compared with the CC group (p= .003). Multiple logistic regression analysis showed that the TI group was 2.96-fold (95% CI, 1.43~6.13) more likely to sustain smoking cessation for 12 months than the CC group. CONCLUSION Findings indicate that multiple interventions initiated during hospital stay and regular follow-up after discharge are more effective than conventional smoking cessation counseling in men with acute ischemic stroke.
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Affiliation(s)
- Min Jeong Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Division of Nursing, Severance Hospital, Seoul, Korea
| | - Eunjeong Park
- Department of Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, (Department of Research Affairs) Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Jin Cha
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Division of Nursing, Severance Hospital, Seoul, Korea.
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Su Q, Li C, Long F, Chen B, Wan Z, Wu Y, Dai M, Wang D, Zhang Y, Wang B. Effects of a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan Province, China. Vascular 2016; 25:242-248. [PMID: 27580820 DOI: 10.1177/1708538116666159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Survivors of ischemic stroke are still at a significant risk for recurrence. Antiplatelet agents are the treatment of first choice for long-term secondary prevention of vascular events. This study aims to assess a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan province, China. In five hospitals from the intervention group, four highly experienced physicians trained 62 neurologists, who in turn trained 613 stroke patients to improve their awareness and adherence to antiplatelet therapy. Physicians and patients of the control group received usual stroke management programs. After one-year follow-up, the proportion of patients who took the antiplatelet therapy increased significantly in the intervention group, reaching 73.2%, with a pre-post difference between two arms of 22.9% ( P < 0.01). There was also a significant net increase in the proportion of patients with awareness of antiplatelet therapy (24.4%, P < 0.01). Multivariate analysis illustrated health promotion program, higher education, annual household income, insurance, and medical status affected antiplatelet drug use in stroke patients. In conclusion, the health promotion program, based on a train-the-trainer approach, showed positive effects on awareness of and adherence to antiplatelet therapy, which has the potential to be scaled up to other resource-limited areas.
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Affiliation(s)
- Qingjie Su
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Chaoyun Li
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Faqing Long
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Bin Chen
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Zhongqin Wan
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Yingman Wu
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Mingming Dai
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Desheng Wang
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Yuhui Zhang
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
| | - Bufei Wang
- Department of Neurology, Hainan Provincial Nongken Hospital, Haikou, People's Republic of China
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Al AlShaikh S, Quinn T, Dunn W, Walters M, Dawson J. Predictive factors of non-adherence to secondary preventative medication after stroke or transient ischaemic attack: A systematic review and meta-analyses. Eur Stroke J 2016; 1:65-75. [PMID: 29900404 PMCID: PMC5992740 DOI: 10.1177/2396987316647187] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Non-adherence to secondary preventative medications after stroke is
relatively common and associated with poorer outcomes. Non-adherence can be
due to a number of patient, disease, medication or institutional factors.
The aim of this review was to identify factors associated with non-adherence
after stroke. Method We performed a systematic review and meta-analysis of studies reporting
factors associated with medication adherence after stroke. We searched
MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Knowledge. We followed
PRISMA guidance. We assessed risk of bias of included studies using a
pre-specified tool based on Cochrane guidance and the Newcastle–Ottawa
scales. Where data allowed, we evaluated summary prevalence of non-adherence
and association of factors commonly reported with medication adherence in
included studies using random-effects model meta-analysis. Findings From 12,237 titles, we included 29 studies in our review. These included
69,137 patients. The majority of included studies (27/29) were considered to
be at high risk of bias mainly due to performance bias. Non-adherence rate
to secondary preventative medication reported by included studies was 30.9%
(95% CI 26.8%–35.3%). Although many factors were reported as related to
adherence in individual studies, on meta-analysis, absent history of atrial
fibrillation (OR 1.02, 95% CI 0.72–1.5), disability (OR 1.27, 95% CI
0.93–1.72), polypharmacy (OR 1.29, 95% CI 0.9–1.9) and age (OR 1.04, 95% CI
0.96–1.14) were not associated with adherence. Discussion This review identified many factors related to adherence to preventative
medications after stroke of which many are modifiable. Commonly reported
factors included concerns about treatment, lack of support with medication
intake, polypharmacy, increased disability and having more severe
stroke. Conclusion Understanding factors associated with medication taking could inform
strategies to improve adherence. Further research should assess whether
interventions to promote adherence also improve outcomes.
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Affiliation(s)
- Sukainah Al AlShaikh
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Terry Quinn
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - William Dunn
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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25
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Maximizing Patient Recruitment and Retention in a Secondary Stroke Prevention Clinical Trial: Lessons Learned from the STAND FIRM Study. J Stroke Cerebrovasc Dis 2016; 25:1371-80. [PMID: 27009610 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recruitment and retention of patients in a clinical trial is important for generalizability and robustness of findings. We aimed to investigate features of a study design that were associated with recruitment and retention in a Phase II and Phase III trial of a secondary prevention program for stroke. METHODS Following informed consent in hospital, Phase II participants were randomized to intervention or usual care. Baseline clinical assessments were conducted at home approximately 3 months after discharge. In Phase III study, informed consent was obtained at home. We compared the characteristics of participants recruited and retained to 12 months for both phases. Interviews with study nurses were undertaken in order to ascertain their opinions of features of study design. Triangulation was used to identify the features of study design that nurses thought had improved recruitment and retention. RESULTS All 24 eligible participants were recruited to the Phase II pilot study (100% recruitment), with 67% retention at 12 months. In Phase III study, 570 participants were recruited, and 93% of these participants had reached their 12-month assessment (n = 532) and were still participating. Consistent with the greater patient retention in Phase III study, nurses reported that patients' willingness to participate was greater when consent was obtained at home. CONCLUSION Following a change in the consent process from hospital to home, more participants continued participation to 12 months. Pilot studies can provide important data to improve study design and better understand potential barriers to recruitment and retention.
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Budimkic MS, Pekmezovic T, Beslac-Bumbasirevic L, Ercegovac M, Berisavac I, Stanarcevic P, Padjen V, Jovanovic DR. Long-term medication persistence in stroke patients treated with intravenous thrombolysis. Clin Neurol Neurosurg 2016; 141:19-22. [DOI: 10.1016/j.clineuro.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/20/2015] [Accepted: 12/09/2015] [Indexed: 11/24/2022]
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27
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Field TS, Castellanos M, Weksler BB, Benavente OR. Antiplatelet Therapy for Secondary Prevention of Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Tsai MJ, Lin MW, Huang YB, Kuo YM, Tsai YH. The Influence of Acute Hyperglycemia in an Animal Model of Lacunar Stroke That Is Induced by Artificial Particle Embolization. Int J Med Sci 2016; 13:347-56. [PMID: 27226775 PMCID: PMC4879767 DOI: 10.7150/ijms.14393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Animal and clinical studies have revealed that hyperglycemia during ischemic stroke increases the stroke's severity and the infarct size in clinical and animal studies. However, no conclusive evidence demonstrates that acute hyperglycemia worsens post-stroke outcomes and increases infarct size in lacunar stroke. In this study, we developed a rat model of lacunar stroke that was induced via the injection of artificial embolic particles during full consciousness. We then used this model to compare the acute influence of hyperglycemia in lacunar stroke and diffuse infarction, by evaluating neurologic behavior and the rate, size, and location of the infarction. The time course of the neurologic deficits was clearly recorded from immediately after induction to 24 h post-stroke in both types of stroke. We found that acute hyperglycemia aggravated the neurologic deficit in diffuse infarction at 24 h after stroke, and also aggravated the cerebral infarct. Furthermore, the infarct volumes of the basal ganglion, thalamus, hippocampus, and cerebellum but not the cortex were positively correlated with serum glucose levels. In contrast, acute hyperglycemia reduced the infarct volume and neurologic symptoms in lacunar stroke within 4 min after stroke induction, and this effect persisted for up to 24 h post-stroke. In conclusion, acute hyperglycemia aggravated the neurologic outcomes in diffuse infarction, although it significantly reduced the size of the cerebral infarct and improved the neurologic deficits in lacunar stroke.
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Affiliation(s)
- Ming-Jun Tsai
- 1. Department of Neurology, China Medical University Hospital, Taichung 404, Taiwan; 2. School of Medicine, China Medical University, Taichung 404, Taiwan; 6. Department of Neurology, China Medical University, An-Nan Hospital, Tainan 709, Taiwan
| | - Ming-Wei Lin
- 3. Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yaw-Bin Huang
- 3. Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan; 4. School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Min Kuo
- 5. Department of Cell Biology and Anatomy, National Cheng Kung University, Tainan 701, Taiwan
| | - Yi-Hung Tsai
- 3. Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Björck F, Renlund H, Svensson PJ, Själander A. Warfarin persistence among stroke patients with atrial fibrillation. Thromb Res 2015; 136:744-8. [PMID: 26254195 DOI: 10.1016/j.thromres.2015.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Warfarin treatment discontinuation is significant among patients with atrial fibrillation (AF). For AF patients with stroke a warfarin persistence rate of 0.45 after 2years has previously been reported. No consistent predictors for discontinuation have been established. AIMS Evaluation of warfarin persistence and variables associated with discontinuation, in a large Swedish cohort with unselected stroke/TIA patients with AF treated with warfarin. MATERIALS AND METHODS 4 583 patients with stroke/TIA and AF in the Swedish National Patient Register (NPR), from 1. Jan 2006 to 31. Dec 2011, were matched with the Swedish national quality register AuriculA. They were followed until treatment cessation, death or end of study. Baseline characteristics and CHA2DS2VASc score were retrieved from NPR. Treatment-time was retrieved from AuriculA. RESULTS Overall proportion of warfarin persistence was 0.78 (95% confidence interval (CI) 0.76 to 0.80) after one year, 0.69 (95% CI 0.67 to 0.71) after 2years and 0.47 (95% CI 0.43 to 0.51) after 5years. Variables clearly associated with higher discontinuation were dementia (hazard ratio (HR) 2.22, CI 1.51-3.27) and alcohol abuse (HR 1.66, CI 1.19-2.33). Chronic obstructive pulmonary disease (COPD), cancer and chronic heart failure (CHF) were each associated with over 20% increased risk of treatment discontinuation. Higher CHA2DS2VASc score and start-age lead to lower persistence (p<0.001). CONCLUSIONS Persistence to warfarin in unselected stroke/TIA patients with AF is in Sweden greater than previously reported. Lower persistence is found among patients with high treatment start-age, incidence of dementia, alcohol abuse, cancer, CHF, COPD and/or high CHA2DS2VASc score.
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Affiliation(s)
- Fredrik Björck
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Henrik Renlund
- Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Peter J Svensson
- Department for Coagulation disorders, University of Lund, Malmö, Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Shah NS, Huffman MD, Ning H, Lloyd‐Jones DM. Trends in myocardial infarction secondary prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012. J Am Heart Assoc 2015; 4:e001709. [PMID: 25904591 PMCID: PMC4579957 DOI: 10.1161/jaha.114.001709] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse. METHODS AND RESULTS We evaluated sex- and race-stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 individuals who self-reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys (NHANES) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011-2012, with significant increases in control rates (as then defined) in men to 85% in 2011-2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non-Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011-2012, and aspirin use increased significantly but only to 28% by 2011-2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non-Hispanic blacks. Projected hypertension control rates remained suboptimal. CONCLUSIONS While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high-risk group.
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Affiliation(s)
- Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.)
- Department of Medicine, Stanford University School of Medicine, Stanford, CA (N.S.S.)
| | - Mark D. Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.)
- Department of Medicine‐Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., D.M.L.J.)
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.)
| | - Donald M. Lloyd‐Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.)
- Department of Medicine‐Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., D.M.L.J.)
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Mouradian MS, Hussain MS, Lari H, Salam A, Senthilselvan A, Dean N, Shuaib A. The Impact of a Stroke Prevention Clinic in Diagnosing Modifiable Risk Factors for Stroke. Can J Neurol Sci 2014; 32:496-500. [PMID: 16408581 DOI: 10.1017/s0317167100004509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT:Objective:To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of pre-referral diagnosis and management of modifiable risk factors for stroke.Methods:We collected prospective data on consecutive patients referred to the SPC at University of Alberta Hospital in Edmonton, Alberta, Canada. Outcome measures included: alternate diagnoses to stroke or transient ischemic attack (TIA), uncontrolled or undiagnosed hypertension, hyperlipidemia and diabetes, therapies, and investigations leading to carotid endarterectomy.Results:Two thousand and eleven patients were referred to SPC. Nearly 25% of the referrals originated from the emergency room and the rest from general physicians. Of the referrals, 68.7% were confirmed as TIA or stroke at the SPC. Among 1381 patients with TIA or stroke, 736 had history of hypertension. Uncontrolled hypertension was found in 265 patients (36.0% of those with hypertension: 95% CI: 32.5–39.5) while undiagnosed hypertension was found in 103 (15.9% of those without hypertension: 95%CI: 13.14-18.79). History of hyperlipidemia was present in 451 patients (32.6%) and 356 (78.9%: 95% CI: 75.2-82.69) of these patients were not at target for secondary prevention. Among 930 patients without history of hyperlipidemia, 739 (79.5%: 95% CI: 76.8-82.1) were diagnosed with hyperlipidemia through the SPC. Fasting blood glucose levels above 7.1 mmol/L in patients with and without history of diabetes were 221 (79.2%: 95% CI: 74.5-83.9) and 66 (6%: 95%CI: 4.6-7.4) respectively.Conclusions:Management of risk factors for stroke needs improvement. SPCs should consider actively managing the classical modifiable risk factors of stroke.
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Boan AD, Egan BM, Bachman DL, Adams RJ, Feng W(W, Jauch EC, Ovbiagele B, Lackland DT. Antihypertensive medication persistence 1-year post-stroke hospitalization. J Clin Hypertens (Greenwich) 2014; 16:869-74. [PMID: 25307229 PMCID: PMC8031794 DOI: 10.1111/jch.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/20/2022]
Abstract
To optimize the translation of clinical trial evidence that antihypertensive treatment reduces recurrent stroke risk into clinical practice, it is important to assess the frequency of long-term antihypertensive drug persistence after stroke and identify the factors associated with low persistence. Structured telephone interviews to determine antihypertensive regimen persistence 1-year post-stroke hospitalization were conducted in 270 stroke survivors, of which 212 (78.5%) were discharged on antihypertensive therapy (two thirds on >1 drug class). Continued use of any antihypertensive agent at 1 year of follow-up was relatively high (87.3%); however, persistence on all or two or more drug classes prescribed at discharge was relatively low (38.7%). Continued use varied by drug class, with the highest rates among angiotensin-converting enzyme inhibitor (69.1%) and the lowest rates among diuretic (24.4%) users. Black patients (adjusted odds ratio, 0.35; 95% confidence interval, 0.16-0.78) and those with a high comorbidity burden (adjusted odds ratio , 0.39; 95% confidence interval, 0.18-0.86) were less likely to exhibit persistence on prescribed treatments 1-year post-stroke hospitalization. These results indicate the need for further study to identify appropriate persistence of antihypertensive therapies for secondary stroke prevention and to investigate reasons for racial disparities in persistence on prescribed treatments in a real-world clinical setting.
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Affiliation(s)
- Andrea D. Boan
- Department of PediatricsMedical University of South CarolinaCharlestonSC
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Brent M. Egan
- Department of Internal MedicineUniversity of South Carolina School of Medicine GreenvilleGreenvilleSC
| | - David L. Bachman
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
| | - Robert J. Adams
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
| | - Wuwei (Wayne) Feng
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
| | - Edward C. Jauch
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
- Division of Emergency MedicineMedical University of South CarolinaCharlestonSC
| | - Bruce Ovbiagele
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
| | - Daniel T. Lackland
- Department of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonSC
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Bauler S, Jacquin-Courtois S, Haesebaert J, Luaute J, Coudeyre E, Feutrier C, Allenet B, Decullier E, Rode G, Janoly-Dumenil A. Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units. Eur Neurol 2014; 72:262-70. [PMID: 25277833 DOI: 10.1159/000362718] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 04/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.
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Affiliation(s)
- Stephanie Bauler
- Pôle de Rééducation et de Réadaptation Fonctionnelles, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
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Adherence to warfarin treatment among patients with atrial fibrillation. Clin Res Cardiol 2014; 103:998-1005. [PMID: 25080281 DOI: 10.1007/s00392-014-0742-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatment with warfarin greatly reduces the risk of stroke related to atrial fibrillation, but will not be effective unless patients adhere to treatment. Lack of fixed dosing makes it difficult to objectively estimate adherence to treatment from prescription data. OBJECTIVE To evaluate two methods that assess adherence to warfarin from prescription data. DESIGN Retrospective study of Swedish health care registers. PATIENTS AND METHODS Age- and sex-specific dose requirements were determined from approx. 1 million blood tests and dosing instructions. By applying these dosages to 163,785 warfarin-treated patients with atrial fibrillation, we calculated the quantity of warfarin that was needed to keep these patients on effective treatment during a mean follow-up of 3.9 years and compared that with the dispensed quantities. The ratio of available drug/time at risk constitutes a measure of adherence on group level. In addition, time intervals between refills were used to assess discontinuation. RESULTS Both methods showed that 45% of the patients did not have enough warfarin to last 80% of the time at risk. Between 16 and 21% of the patients discontinued within the first year, followed by 8-9% annually during the following years. Patients with high bleeding risk and patients with low embolic risk showed lower endurance. CONCLUSIONS Adherence to treatment with warfarin can be estimated on group level from prescription data and may be useful for comparison of adherence with warfarin and new oral anticoagulants. When applied to a large warfarin-treated cohort with atrial fibrillation, we found that adherence is low and that measures aiming for improvements are needed .
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Duffy D, Kelly E, Trang A, Whellan D, Mills G. Aspirin for cardioprotection and strategies to improve patient adherence. Postgrad Med 2014; 126:18-28. [PMID: 24393748 DOI: 10.3810/pgm.2014.01.2721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in North America. Aspirin therapy has proven clinical effectiveness in the prevention and treatment of CVD and is one of the most widely used drugs nationwide. However, despite the medication's popularity and utility, adherence to a proper aspirin regimen is suboptimal, resulting in adverse health outcomes and increased health care costs. Our review outlines current knowledge on aspirin therapy adherence, causes of nonadherence, and strategies available to increase adherence to aspirin and medications in general. We demonstrate that, indeed, aspirin adherence rates are suboptimal, ranging from 72% to 92%, and that a combination of patient- and medication-related factors contribute to nonadherence. A multidimensional approach involving patient education and medication innovations to reduce aspirin side effects is imperative to improving rates of aspirin therapy adherence.
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Affiliation(s)
- Danielle Duffy
- Assistant Professor, Division of Cardiology, Jefferson Medical College.
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Long-term Adherence to National Guidelines for Secondary Prevention of Ischemic Stroke: A Prospective Cohort Study in a Public Hospital in Chile. J Stroke Cerebrovasc Dis 2014; 23:490-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 01/29/2023] Open
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Østergaard K, Madsen C, Liu ML, Bak S, Hallas J, Gaist D. Long-term use of antiplatelet drugs by patients with transient ischaemic attack. Eur J Clin Pharmacol 2013; 70:241-8. [PMID: 24247641 DOI: 10.1007/s00228-013-1609-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/31/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the degree of long-term non-persistence to antiplatelet drugs in patients with transient ischaemic attack (TIA) and identify determinants of this drug-use pattern. METHODS We used community-based prescription registry data to determine antiplatelet drug use in TIA patients presenting to a Danish neurology department in the period 2006-2010. Non-persistence was defined as failure to present a prescription for antiplatelet drugs within 180 days after the dosage of a previous prescription had run out. We used Cox regression to calculate the hazard ratio (HR) for non-persistence and the corresponding 95 % confidence interval (CI) by potential determinants, including a stroke risk score (ABCD2 score). Adherence during follow-up [80 % medication possession ratio (MPR80)] was calculated for antiplatelets, statins and antihypertensive drugs. RESULTS The cohort comprised 594 (84 % evaluated as in-patients) TIA patients. During follow-up (median 1.7 years, interquartile range 0.9-3.0 years), 140 (23.6 %) patients became non-persistent. Non-persistence was associated with younger age (<55 years: HR 1.9, 95 % CI 1.3-2.8) and delay between TIA onset and neurological evaluation (7+ days: HR 2.0, 95 % CI 1.0-4.1). Among admitted patients, a higher ABCD2 score (4+: HR 1.3, 95 % CI 0.8-2.1) was also indicative of non-persistence. Non-persistent users were less adherent to other preventive medication (MPR80: statins 31.8 vs. 75.3 %, p value < 0.001; antihypertensives 64.3 vs. 79.5 %, p value: 0.02) than persistent users. CONCLUSION Long-term antiplatelet non-persistence was most pronounced in patients of younger age, those with delayed evaluation of symptoms and those at greater risk of stroke. It was also associated with a lower adherence to preventive medication in general.
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Affiliation(s)
- Kamilla Østergaard
- Department of Neurology, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark
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Suljic E, Mehicevic A, Gavranovic A. Stroke emergency medical care: initial assessment, risk factors, triage and hospitalization outcome. Mater Sociomed 2013; 25:83-7. [PMID: 24082828 PMCID: PMC3769086 DOI: 10.5455/msm.2013.25.83-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/05/2013] [Indexed: 11/03/2022] Open
Abstract
CONFLICT OF INTEREST none declared. GOALS THE GOALS OF THIS RESEARCH ARE: a) to determine the number, gender and age representation of patients with a working diagnosis of acute stroke referred by the Institute for Emergency Medical Care (IEMC) in the Clinical Center of Sarajevo University (CCSU); b) determine the incidence of patients that have been or have not been hospitalized and why; c) determine the time and procedure for emergency medical care; d) to determine the characteristics and outcomes of patients hospitalized with ischemic stroke at the Neurology Clinic CCUS. MATERIAL AND METHODS The study was retrospective and included time period from 1st June 2010 to 30th November 2010. The study included patients of both sexes, older than 18 years of age. RESULTS The study included a total of 233 patients. Of these, 65% are female, while 35% of patients were male. Of 82 patients who were admitted to hospital treatment at the Neurology Clinic, 55% of the patients were male and 45% female. The largest number of patients is older than 70 years (71%). Minimum time for emergency medical team arrival was 6 minutes and maximum 70 minutes (mean 35, SD 11.989). Motor weakness was noted in 31% of patients - left sided motor weakness was significantly more represented. In 73% of patients the diagnosis was confirmed. In 5% of patients thrombolytic therapy was administered, while 95% of patients were treated conservatively. Lethal outcome occurred in 30% of hospitalized patients, 37% were discharged as recovered, 30% were discharged as unaltered state, while 3% were discharged with worsening symptoms. Among risk factors, hypertension is the leading one, followed by an earlier stroke, diabetes mellitus, and cardiac arrhythmias. CONCLUSIONS In 91% of patients consciousness was preserved. In 73% of transported patients has been confirmed the diagnosis of ischemic stroke. Of the patients with confirmed diagnosis 59% were hospitalized. A significant number of strokes occur for the first time in relation to relapse. 5% of patients were treated with thrombolysis, while others were treated with conservative therapy. Recurrent stroke and patient confusion have significant impact on the outcome.
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Affiliation(s)
- Enra Suljic
- Neurology Clinic, Clinical Center of Sarajevo University , Bosnia and Herzegovina
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Wang Y, Wu D, Wang Y, Ma R, Wang C, Zhao W. A survey on adherence to secondary ischemic stroke prevention. Neurol Res 2013; 28:16-20. [PMID: 16464357 DOI: 10.1179/016164106x91816] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Reduced adherence and compliance to discharge instructions and protocols could significantly influence the ability of any stroke prevention strategy. The goals of this investigation were to evaluate the adherence to secondary prevention strategies within 1 year after ischemic stroke and to identify possible causes of poor compliance with these strategies. Patients who had suffered either acute ischemic stroke or transient ischemic attacks (TIA) were recruited retrospectively through telephone follow-up. The survey included whether the patient was prescribed antithrombotic treatment at discharge and reasons for non-compliance with this prescription both immediately after discharge and 1 year after discharge. Of 472 (73.8%) patients with detailed clinical data who were finally evaluated in this survey, 326 (69.1%) were still under antithrombotic treatment and 172 (36.4%) underwent the same antithrombotic agent as prescribed when discharged. We found that medical insurance and free medical care were able to promote compliance with medication in stroke patients for secondary prevention, while administration of non-aspirin antithrombotic agents or a poor ability for daily activities (Barthel index, BI) had significantly negative effects on medication compliance in stroke patients. Under the conditions of this observational study, adherence to stroke prevention strategies was poor. Income levels, categories of antithrombotic agents and the personal living ability are closely related to compliance. The results suggest that doctors should pay more attention to the secondary prevention of stroke. We suggest that providing stroke patients with detailed instructions for medication usage, physicians could increase the potential that their secondary prevention of stroke could be increased.
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Affiliation(s)
- Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital University of Medical Sciences, Chongwen Disrict, Beijing 100050, China.
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Divani AA, Zantek ND, Borhani-Haghighi A, Rao GHR. Antiplatelet therapy: aspirin resistance and all that jazz! Clin Appl Thromb Hemost 2012; 19:5-18. [PMID: 22751909 DOI: 10.1177/1076029612449197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Platelets play a crucial role in the pathogenesis of atherosclerosis, thrombosis, and stroke. Aspirin used alone or in combination with other antiplatelet drugs has been shown to offer significant benefit to patients at high risk of vascular events. Resistance to the action of aspirin may decrease this benefit. Aspirin resistance has been defined by clinical and/or laboratory criteria; however, detection by laboratory methods prior to experiencing a clinical event will likely provide the greatest opportunity for intervention. Numerous laboratory methods with different cutoff points have been used to evaluate the resistance. Noncompliance with aspirin treatment has also confounded studies. A single assay is currently insufficient to establish resistance. Combinations of results to confirm compliance and platelet inhibition may identify "at-risk" individuals who truly have aspirin resistance. The most effective strategy for managing patients with aspirin resistance is unknown; however, studies are currently underway to address this issue.
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Affiliation(s)
- Afshin A Divani
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA.
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Østergaard K, Hallas J, Bak S, Christensen RD, Gaist D. Long-term use of antiplatelet drugs by stroke patients: a follow-up study based on prescription register data. Eur J Clin Pharmacol 2012; 68:1631-7. [PMID: 22576729 DOI: 10.1007/s00228-012-1293-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/13/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Treatment with antiplatelet drugs is a key element of secondary stroke prevention. We investigated long-term antiplatelet drug use in stroke patients with a focus on non-persistence. METHODS Population-based prescription register data were used to determine antiplatelet drug use in a cohort of stroke patients discharged from a Danish neurology department. The antiplatelet drugs comprised acetylsalicylic acid (ASA), clopidogrel and dipyridamole (if combined with ASA use). Non-persistence was defined as failure to present a prescription for antiplatelet drugs within 180 days after the dosage of a previous prescription had run out, or within 180 days after discharge. Cox regression was used to identify risk factors for non-persistence. RESULTS The cohort comprised 503 patients with ischaemic stroke discharged in 1999-2001. During follow-up (median 2.8 years, interquartile range 0.8-7.8 years), 486 of the subjects presented prescriptions for antiplatelets. Most subjects used a dual regimen of ASA and dipyridamole (N = 320). Of 110 non-persistent subjects in this group, 64 stopped using ASA, but continued to use dipyridamole in monotherapy. Overall, 181 patients (36 %) were non-persistent. Stroke severity was inversely associated with the risk of non-persistence [NIHSS score on admission 0-3 (reference); 4-6: hazard risk (HR) 0.87, 95 % confidence interval (CI) 0.61-1.25; 7+: HR 0.47, 95 % CI 0.29-0.74]. CONCLUSIONS Long-term non-persistence with antiplatelet treatment was high and more pronounced in our patients with less severe stroke. Our findings on the use of ASA and dipyridamole indicate that non-persistence may in part be amenable to simple intervention measures.
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Affiliation(s)
- Kamilla Østergaard
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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Coetzee N, Andrewes D, Khan F, Hale T, Jenkins L, Lincoln N, Disler P. Predicting Compliance With Treatment Following Stroke: A New Model of Adherence Following Rehabilitation. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.9.2.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground and purpose: Adherence to medication is fundamental to optimal health recovery yet compliance to medication rates are lower than 50% in most studies. This study aimed to investigate the correlates of adherence in stroke patients. Method: Twenty-six stroke patients and 29 amputee patients who had completed a rehabilitation program at Melbourne Rehabilitation Centre were investigated. Medical adherence was determined from computed adherence metrics based on pill counts and subjective reports of patient knowledge of medication use. Model components that were believed to contribute to poor adherence, included emotional and cognitive dysfunction, beliefs about medication, and social support. These factors were assessed by patient and partner self-rating questionnaires. Results: Stroke patients showed a lower level of adherence compared to amputee patients. Cognitive and emotional dysfunction, beliefs about medication, and the level of care were significantly associated with low adherence to medicine regimes in stroke patients. Level of cognitive impairment and emotional impairment were significantly associated with low adherence to medicines in amputee patients. Emotional dysfunction was the best predictor of poor adherence in both patient groups. Conclusion: The findings are in keeping with past adherence studies with other patient groups and support the position that emotional, cognitive, and social factors are important factors in adherence. The specific nonadherence profile for this brain-damaged group is modeled and the application for outpatients following rehabilitation is discussed.
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Wiszniewska M, Głuszkiewicz M, Kobayashi A, Włodek A, Jezierska-Ostapczuk A, Fryze W, Członkowska A. Knowledge of Risk Factors and Stroke Symptoms among Nonstroke Patients. Eur Neurol 2012; 67:220-5. [DOI: 10.1159/000335569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 12/04/2011] [Indexed: 11/19/2022]
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Flynn RW, MacDonald TM, Murray GD, MacWalter RS, Doney AS. Persistence, Adherence and Outcomes with Antiplatelet Regimens following Cerebral Infarction in the Tayside Stroke Cohort. Cerebrovasc Dis 2012; 33:190-7. [DOI: 10.1159/000331933] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/10/2011] [Indexed: 11/19/2022] Open
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Brunner Frandsen N, Sorensen M, Hyldahl TK, Henriksen RM, Bak S. Smoking Cessation Intervention After Ischemic Stroke or Transient Ischemic Attack. A Randomized Controlled Pilot Trial. Nicotine Tob Res 2011; 14:443-7. [DOI: 10.1093/ntr/ntr233] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sjölander M, Eriksson M, Glader EL. Few sex differences in the use of drugs for secondary prevention after stroke: a nationwide observational study. Pharmacoepidemiol Drug Saf 2011; 21:911-9. [DOI: 10.1002/pds.2268] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 09/07/2011] [Accepted: 09/19/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience; Umeå University; S-901 85; Umeå; Sweden
| | | | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine; Umeå University; Umeå; Sweden
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Maasland L, Brouwer-Goossensen D, den Hertog HM, Koudstaal PJ, Dippel DWJ. Health education in patients with a recent stroke or transient ischaemic attack: a comprehensive review. Int J Stroke 2011; 6:67-74. [PMID: 21205243 DOI: 10.1111/j.1747-4949.2010.00541.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health education aims at the acquisition of skills and attitudes to modify behaviour that influences health, leads to a modification of risk factors and ultimately to a decrease in disability and case fatality from stroke. Health education is an underdeveloped but important aspect of stroke care. Health education could promote compliance and healthy behaviour, improve patients' understanding of their health status and treatment options and facilitate communication. We reviewed the effect of health education in stroke and transient ischaemic attack patients, aiming at feasibility, effectiveness at the level of knowledge, attitude and skills, health behaviour changes and stroke outcome. We also describe the current status of health education for patients with recent coronary artery disease and public health education in stroke. Basic knowledge of stroke and transient ischaemic attack patients of their disease and associated risk factors is not sufficient. This is also observed in patients with coronary artery disease and in the general population. A beneficial effect of health education in stroke and transient ischaemic attack patients on health behaviour, risk reduction or stroke outcome has not been proven. Trials in patients with coronary artery disease, however, have shown that health education could result in a change of lifestyle. No specific method is superior, although the individualised, repetitive and active methods appear more successful. More intervention studies of health education in stroke and transient ischaemic attack patients are needed. Future trials should be large, have a long follow-up, should use an intensive and repetitive approach and involve patients' relatives to induce and maintain a healthy lifestyle.
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Affiliation(s)
- Lisette Maasland
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Chambers JA, O’Carroll RE, Hamilton B, Whittaker J, Johnston M, Sudlow C, Dennis M. Adherence to medication in stroke survivors: A qualitative comparison of low and high adherers. Br J Health Psychol 2010; 16:592-609. [DOI: 10.1348/2044-8287.002000] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Slark J. Adherence to secondary prevention strategies after stroke: A review of the literature. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjnn.2010.6.6.77883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julia Slark
- Imperial College Cerebrovascular Research Unit (ICCRU), Charing Cross Hospital, Fulham Palace Road, Hammersmith, London W6 8RF
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