scholarly journals Secondary Stroke Prevention in Polish Adults: Results from the LIPIDOGRAM2015 Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4472
Author(s):  
Beata Labuz-Roszak ◽  
Maciej Banach ◽  
Michal Skrzypek ◽  
Adam Windak ◽  
Tomasz Tomasik ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Lifestyle Modification ◽  
Antihypertensive Drugs ◽  
Lipid Lowering ◽  
Secondary Stroke Prevention ◽  
Anticoagulant Treatment ◽  
Place Of Residence ◽  
Anticoagulation Agents ◽  
Preventive Medication ◽  
History Of

Background: The purpose of the study was to evaluate secondary stroke prevention in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methods: From all patients in LIPIDOGRAM2015 Study (n = 13,724), 268 subjects had a history of ischaemic stroke and were included. Results: 165 subjects (61.6%) used at least one preventive medication. Oral antiplatelet and anticoagulation agents were used by 116 (43.3%) and 70 (26.1%) patients, respectively. Only 157 (58.6%) participants used lipid-lowering drugs, and 205 (76.5%) were treated with antihypertensive drugs. Coronary heart disease (CHD) and dyslipidaemia were associated with antiplatelet treatment (p = 0.047 and p = 0.012, respectively). A history of atrial fibrillation, CHD, and previous myocardial infarction correlated with anticoagulant treatment (p = 0.001, p = 0.011, and p < 0.0001, respectively). Age, gender, time from stroke onset, place of residence, and level of education were not associated with antiplatelet or anticoagulant treatment. Only 31.7% of patients were engaged in regular physical activity, 62% used appropriate diet, and 13.6% were current smokers. Conclusions: In Poland drugs and lifestyle modification for secondary stroke prevention are not commonly adhered to. Educational programmes for physicians and patients should be developed to improve application of effective secondary prevention of stroke.

Abstract TMP68: Vulnerability to Health Disparities and Secondary Stroke Prevention: The REGARDS Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
James. D Rhodes ◽  
Asikhame Oikeh ◽  
Chris Gamboa ◽  
Abimbola Fadairo ◽  
Suzanne Judd ◽  
...  
Keyword(s):  
Health Disparities ◽  
Stroke Prevention ◽  
Healthcare Providers ◽  
Lipid Lowering ◽  
Inverse Association ◽  
Secondary Stroke Prevention ◽  
Stroke Event ◽  
Point Increase ◽  
National Cohort ◽  
Regards Study

There are few studies on the effect of multiple vulnerabilities to health disparities identified in the AHRQ 2012 report on secondary stroke prevention. We examined the effects of 5 vulnerability domains (race, age, region, health insurance and income) on the prescription of secondary stroke prevention medications at discharge following hospitalization for an acute ischemic stroke (AIS) in a large, national cohort of patients admitted to unselected hospitals. Methods: We conducted a retrospective review of admissions for AIS between 2003-2012 within the REGARDS cohort. Discharge medications, insurance status, and age at time of stroke event were obtained from hospital records. Race, region and income < $20,000 were obtained from REGARDS baseline data. We constructed a vulnerability score (v score) range from 0-5, with 0 indicating no vulnerability. We examined the prevalence of each discharge medication by each vulnerability domain, score category, and by overall score using Poisson regression with a robust variance estimator. Results: 664 participants met the inclusion criteria. 132 (20%) of the study participants had ≥ 3 vulnerabilities (v score of 3-5). Participants with ≥ 3 vulnerabilities were more likely to be black (80.3%), > 75 years old (63.6%), and to report income < $20,000 (67.4%). The prevalence of receiving antithrombotic prescriptions at discharge was significantly lower in participants with ≥ 3 vulnerability domains (PR: 0.90 [95% CI: 0.82, 0.99]). The prevalence of receiving antithrombotic prescriptions was also inversely associated with a per point increase of the v score (PR: 0.96 [95% CI: 0.93, 0.99]), as were lipid- lowering prescriptions at discharge (PR: 0.95 [CI: 0.90, 0.99]). There was a non-statistically significant inverse association between ACEi/ARB prescriptions at discharge and having multiple vulnerabilities, including for 2 vulnerabilities (PR: 0.93 [CI: 0.80, 1.09]) and for ≥ 3 vulnerabilities (PR: 0.84 [CI: 0.69, 1.01]). Conclusion: The presence of multiple vulnerabilities was associated with lower adherence by healthcare providers to secondary stroke prevention recommendations for discharge prescriptions.

Family Perceptions of Barriers and Facilitators of Treatment Protocols for Secondary Stroke Prevention in Children with Sickle Cell Disease

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4805-4805
Author(s):  
Eve S Puffer ◽  
Melanie J Bonner ◽  
Courtney D Thornburg
Keyword(s):  
Iron Overload ◽  
Sickle Cell ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Iron Chelation ◽  
Secondary Stroke Prevention ◽  
Treatment Protocols ◽  
History Of ◽  
Family Perceptions

Abstract Abstract 4805 Children with sickle cell anemia (SCA) and a primary overt stroke are at high risk of recurrent (secondary) stroke. Chronic blood transfusion (CBT) dramatically reduces but does not eliminate this high risk, and results in transfusion-related hemosiderosis. We previously reported the use of hydroxyurea/phlebotomy as an alternative to CBT to reduce the risk of secondary stroke and improve management of iron overload (Ware et al. J Pediatr 2004). This study examines the caregiver and child experience with secondary stroke prevention. Individual semi-structured interviews were conducted with primary caregivers and children/adolescents (age > 5 years) recruited from the Duke Pediatric Sickle Cell Program. The interviewer (E.P.) asked about perceptions of risk of recurrent stroke and iron overload with and without therapy and facilitators and barriers of therapy. Interviews were coded and analyzed independently by two investigators (E.P and C.T.). The sample included 14 youth (10 males) with a median age of 12.5 years (range 3–17). All primary caregivers were female. Twelve children had a history of overt stroke and 2 had a history of silent stroke. All children had experience with CBT and 9 were receiving CBT at the time of the interview. Eleven children had experience taking hydroxyurea and 5 were taking hydroxyurea at the time of the interview. All caregivers agreed that their child was at risk of recurrent stroke, identified benefit of current treatment and reported high motivation to adhere to treatment protocols. They noted significant impact that stroke had on school functioning, attention, personality, participation in sports and overall quality of life. Caregiver-reported barriers to CBT and hydroxyurea fell into three main categories: (1) missed work and school and related consequences; (2) unexpected resource-related challenges; and (3) inconvenience of clinic appointments, all of which contributed to burden on the family and sometimes missed clinic appointments and treatments. There were higher levels of concern expressed by caregivers of children on CBT related to the higher frequency and longer length of medical appointments compared with those taking hydroxyurea. The primary child-reported barrier was dislike of needles or shots (although this decreased with age as expected); those taking hydroxyurea also noted that they sometimes forgot to take the medication if they were busy with other activities or fell asleep. Caregiver-reported facilitators of CBT and hydroxyurea included: (1) understanding importance of stroke prevention and connection to consistent treatment; (2) ancillary benefits of treatments in addition to stroke prevention; (3) link between treatment and long-term benefits. Caregivers were able to overcome treatment barriers via the following: (1) logistical supports including appointment and medication reminders; (2) shared responsibility with other family members including the child; (3) trust in medical staff; and (4) faith. Although children disliked needles and shots, many enjoyed the clinic visits due to fun activities in the clinic setting and rewards. In addition, iron overload was a significant concern for caregivers. For those with children on CBT, knowledge of the risks of iron overload motivated adherence with oral iron chelation. Automatic refills facilitated adherence with chelation therapy, but the taste of the medication was a major barrier to adequate iron chelation. Caregivers of children taking hydroxyurea noted the benefit of avoiding iron overload. Of those who had undergone phlebotomy, in-home phlebotomy was noted as a facilitator, though requirement for IV contributed to negative perception. In summary, as clinicians review options for secondary stroke prevention with families, they should discuss family perceptions and individual barriers and facilitators which may impact adherence with therapy and long-term outcome. Future research should also investigate whether these family perceptions predict actual adherence to protocols and treatment outcomes. Disclosures: Off Label Use: Hydroxyurea for secondary stroke prevention in sickle cell disease.

scholarly journals ADHERENCE TO SECONDARY STROKE PREVENTION THERAPIES IN ISCHEMIC STROKE PATIENTS AT TEACHING HOSPITAL IN CENTRAL JAVA INDONESIA

2017 ◽  
Vol 10 (14) ◽  
pp. 28 ◽  
Author(s):  
Hidayah Karuniawati ◽  
Zullies Ikawati ◽  
Abdul Gofir
Keyword(s):  
Teaching Hospital ◽  
Stroke Prevention ◽  
Quantitative Research ◽  
Recurrent Stroke ◽  
Heart Association ◽  
Lipid Lowering ◽  
Secondary Stroke Prevention ◽  
Central Java ◽  
Number Of Patients ◽  
High Adherence

Objective: Patients who survive from the first stroke have risk factors to be recurrent. Based on American Heart Association/American Stroke Association and PERDOSSI (Indonesian Neurologist Association), medications which are prescribed to reduce the risk of recurrent stroke as secondary stroke prevention therapies include antiplatelet/anticoagulant as well as antihypertensive and lipid lowering agent. Patients’ adherence to the secondary stroke prevention therapies is important to reduce the recurrent stroke. Methods: This is a quantitative research and the data was collected retrospectively. The number of subjects of this study were 165 respondents. The participants were interviewed by researchers about their adherence to secondary stroke prevention by Modified Morisky Adherence Scale 8 (MMAS-8) questionnaire. Patients’ adherence was stated as low (MMAS-8 score < 6); moderate (MMAS-8 score = 6-7) and high (MMAS-8 = 8). This research was taken at a teaching hospital in Central Java Indonesia.Results: Of 165 participants, 48 participants (29%) were categorized to have low adherence, 43 participants (26%) had moderate adherence, and 74 participants (45%) had high adherence to secondary stroke prevention therapies. The reasons for not adhering to the medications were felt better (34.1%), forgetfulness (18.7%), boredom (16.5%), lack of family support (8.8%), lack of time (6.6%), felt worse (5.5%), concern about side effects (3.3%), preference to Complementary Alternative Medicines (3.3%), and cost (3.3%).Conclusion: The number of patients who has high adherence to secondary stroke prevention was 45% and the most common reason why participants did not adhere to therapy was because they felt better (34.1%).   

Deprescribing in Older Adults With Cancer and Limited Life Expectancy: An Integrative Review

2021 ◽  
pp. 104990912110030
Author(s):  
Edwin J. Brokaar ◽  
Frederiek van den Bos ◽  
Loes E. Visser ◽  
Johanneke E. A. Portielje
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Life Expectancy ◽  
Antihypertensive Drugs ◽  
Lipid Lowering ◽  
Potentially Inappropriate Medications ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Preventive Medication

Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.

scholarly journals Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Alicia DeFelipe-Mimbrera ◽  
Araceli Alonso Cánovas ◽  
Marta Guillán ◽  
Consuelo Matute ◽  
Susana Sainz de la Maza ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Stroke Prevention ◽  
Dabigatran Etexilate ◽  
Previous History ◽  
Secondary Stroke Prevention ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Ischemic Complications ◽  
History Of

Introduction. Our aim was to analyze our clinical experience with dabigatran etexilate in secondary stroke prevention.Methods. We retrospectively included patients starting dabigatran etexilate for secondary stroke prevention from March 2010 to December 2012. Efficacy and safety variables were registered.Results. 106 patients were included, median follow-up of 12 months (range 1–31). Fifty-six females (52.8%), mean age 76.4 (range 50–95, SD 9.8), median CHADS2 4 (range 2–6), CHA2DS2-VASc 5 (range 2–9), and HAS-BLED 2 (range 1–5). Indication for dabigatran etexilate was ischemic stroke in 101 patients and acute cerebral hemorrhage (CH) due to warfarin in 5 (4.7%). Dabigatran etexilate 110 mg bid was prescribed in 71 cases (67%) and 150 mg bid was prescribed in the remaining. Seventeen patients (16%) suffered 20 complications during follow-up. Ischemic complications (10) were 6 transient ischemic attacks (TIA), 3 ischemic strokes, and 1 acute coronary syndrome. Hemorrhagic complications (10) were CH (1), gastrointestinal bleeding (6), mild hematuria (2), and mild metrorrhagia (1), leading to dabigatran etexilate discontinuation in 3 patients. Patients with previous CH remained uneventful. Three patients died (pneumonia, congestive heart failure, and acute cholecystitis) and 9 were lost during follow-up.Conclusions. Dabigatran etexilate was safe and effective in secondary stroke prevention in clinical practice, including a small number of patients with previous history of CH.

scholarly journals Secondary Stroke Prevention: Practice Patterns in a Tertiary Care Stroke Service

2010 ◽  
Vol 37 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Janice C. Fan ◽  
Tania M. Mysak ◽  
Thomas J. Jeerakathil ◽  
Glen J. Pearson
Keyword(s):  
Smoking Cessation ◽  
Stroke Prevention ◽  
Tertiary Care ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Secondary Stroke Prevention ◽  
Preventative Care ◽  
Stroke Service ◽  
Care Gaps ◽  
Cerebral Event

Background:Stroke and transient ischemic attack (TIA) have a high personal and financial cost to society and prevention is critical. Outside of registries in Ontario, there has been little effort to determine whether care gaps exist for secondary preventative care within Canada. The objective of this study was to evaluate inpatient medical team compliance to four secondary stroke prevention interventions: antithrombotic therapy, antihypertensive therapy, lipid lowering therapy and smoking cessation.Methods:Adults admitted to the University of Alberta Hospital stroke service with a diagnosis of stroke or TIA between August 1st, 2005 and July 31st, 2006 were identified using International Classification of Diseases (10th Revision) codes. Two hundred charts were randomly selected for retrospective review. Compliance, defined as achievement of therapeutic targets or appropriate therapy for subtherapeutic targets, was assessed.Results:Among 190 eligible patients (mean age 67 years, 55 % male), 147 (77.4%) had a non-cardioembolic cerebral event while 43 (22.6%) had a cardioembolic cerebral event. We found high compliance for antithrombotic (92% [174/190]) and antihypertensive (95% [136/143]) agents, but suboptimal compliance for lipid lowering agents (68% [107/158]) and smoking cessation (27% [17/64]).Conclusions:There is room for improvement in early risk factor management for secondary prevention, even in specialized stroke centres. To optimize stroke preventative care, more interdisciplinary collaboration, investigation of reasons for suboptimal care, development of strategies to minimize care gaps and ongoing stroke care audits for quality improvement are needed.

Abstract P207: Medication Use for Secondary Stroke Prevention and Vascular RIsk Factor Modification Remains Low Among Americans

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Karen C Albright ◽  
Rikki M Tanner ◽  
Amelia K Boehme ◽  
T. Mark Beasley
Keyword(s):  
Risk Factor ◽  
Stroke Prevention ◽  
Medication Use ◽  
Prescription Medication ◽  
Vascular Risk Factor ◽  
Secondary Stroke Prevention ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
History Of ◽  
Factor Modification

Background: With a US prevalence of 795,000 strokes per year and stroke recurrence rates up to 20%, the objective of this study was to determine the prevalence of prescription medication use for secondary stroke prevention and vascular risk factor modification among noninstitutionalized US adults and compare medication use in Whites and Blacks. Methods: A cross-sectional study was performed as part of the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Demographic, disease, and prescription medication use were obtained via a standardized interview. Participants were asked if they had ever been told by a health professional that they had hypertension, diabetes, high cholesterol, or a stroke. Additionally, participants were asked if they had taken or used any prescription medicine in the past month as well as the names of each prescription medication. Statistical analyses used NHANES sample weights to provide prevalence estimates for the US population. Results: Among 11,375 participants (21% Black, 47.6% men, age 20-80), medication use for secondary stroke prevention and vascular risk factors remained low (Table 1). Participants who reported taking either an antiplatelet agent or an anticoagulant with a history of stroke remained low (7.9% Whites vs 6.2% Blacks). More Blacks with hypertension reported taking blood pressure lowering agents (38.9 vs 36.1% Whites). Diabetic medication use was lower in Blacks reporting a history of diabetes (24.5 vs 25.7% Whites). Medication use rates were lowest in participants reporting high cholesterol, with more Whites reporting use of a cholesterol lowering medication (19.3 vs 14.6%; p<0.001). Conclusion: Despite the prevalence of stroke and vascular risk factors, only a small proportion of people at risk are on medications for secondary stroke prevention and vascular risk factor modification. Overall, Blacks were taking fewer medications for secondary stroke prevention and vascular risk factor modification with the exception of anti-hypertension medication.

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