Use of secondary medical prophylaxis and clinical outcome among patients with ischemic stroke: a nationwide follow-up study.
OBJECTIVE
Although secondary medical prevention strategies in patients with stroke are well established, only sparse data exist regarding their effectiveness in routine care. We examined the effectiveness in a nationwide, population-based follow-up study.


METHODS
Using data from the Danish National Indicator Project (DNIP), 28,612 patients hospitalized for ischemic stroke in 2003 to 2006 were identified. Information on drug use and outcomes was by individual-level record linkage with national medical databases. Hazard ratios were computed for death, myocardial infarction, and recurrent stroke according to drug use after hospital discharge.


RESULTS
Treatment with antiplatelets, oral anticoagulants, antihypertensives, or statins was associated with a lower risk of the combined end point of death, myocardial infarction, or recurrent stroke during a mean follow-up period of 2.7 years (adjusted hazard ratios [HRs] from 0.44 [95% CI, 0.39-0.49] to 0.94 [95% CI, 0.89-0.99]). All drug classes were associated with lower risk of death (adjusted HRs from 0.36 [95% CI, 0.32-0.41] to 0.85 [95% CI, 0.80-0.90]), with oral anticoagulant treatment in patients with atrial fibrillation being particularly effective in elderly women (>80 years; adjusted HR, 0.35; 95% CI, 0.28-0.45). Oral anticoagulant treatment was associated with a lower risk of recurrent stroke (adjusted HR, 0.58; 95% CI, 0.47-0.73), and statins were associated with a lower risk of myocardial infarction (adjusted HR, 0.84; 95% CI, 0.73-0.97) and recurrent stroke (adjusted HR, 0.86; 95% CI, 0.79-0.92).


CONCLUSIONS
Secondary medical prophylaxis after ischemic stroke was associated with improved outcome in routine settings. Although these findings are of an observational nature, they tend to support the results from previous randomized trials.
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. kdp@dce.au.dk
Kaare Haurvig
KH
Palnum
Frank
F
Mehnert
Grethe
G
Andersen
Annette
A
Ingeman
Birgitte Randrup
BR
Krog
Paul Daniel
PD
Bartels
Søren Paaske
SP
Johnsen
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy; D003627:Data Interpretation, Statistical; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D057216:Propensity Score; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors