title: Discharge is a critical time to influence 10-year use of secondary prevention therapies for stroke.
abstract: OBJECTIVE
  When optimally managed, patients with stroke are less likely to have further vascular events. We aimed to identify factors associated with optimal use of secondary prevention therapies in long-term survivors of stroke.
  
  
  METHODS
  We carefully documented discharge medications at baseline and self-reported use of medications at annual follow-up in the Northeast Melbourne Stroke Incidence Study (NEMESIS). We defined optimal medication use when patients reported taking (1) antihypertensive agents and (2) statin and antithrombotic agents (ischemic stroke only). Logistic regression was used to assess factors associated with optimal medication use between 2 and 10 years after stroke.
  
  
  RESULTS
  We recruited 1241 patients with stroke. Optimal prescription at discharge from hospital was the most important factor associated with optimal medication use at each time point: odds ratio (OR), 32.2 (95% confidence interval [CI], 13.6-76.1) at 2 years; OR, 7.86 (95% CI, 4.48-13.8) at 5 years (425 of 505 survivors); OR, 6.04 (95% CI, 3.18-11.5) at 7 years (326 of 390 survivors); and OR, 2.62 (95% CI, 1.19-5.77) at 10 years (256 of 293 survivors). Associations were similar in men and women. The association between optimal prescription at discharge and optimal medication use at each time point was greater in those who were not disadvantaged, particularly women.
  
  
  CONCLUSIONS
  Prescription of medications at hospital discharge was the strongest predictor of ongoing medication use in survivors of stroke, even at 10 years after stroke. Ensuring that patients with stroke are discharged on optimal medications is likely to improve their long-term management, but further strategies might be required among those who are disadvantaged.
authors: From the Department of Medicine, Southern Clinical School (A.G.T., J.K., S.A.), and Department of Physiology (V.D., R.G.E.), Monash University, Melbourne, Victoria, Australia; Florey Neuroscience Institutes, Heidelberg, Victoria, Australia (A.G.T.); Menzies Research Institute, University of Tasmania, Tasmania, Australia (S.L.G.); and Caulfield Hospital, Caulfield, Victoria, Australia (M.L.).
authors: Amanda G
authors: AG
authors: Thrift
authors: Joosup
authors: J
authors: Kim
authors: Vatche
authors: V
authors: Douzmanian
authors: Seana L
authors: SL
authors: Gall
authors: Simin
authors: S
authors: Arabshahi
authors: Michelle
authors: M
authors: Loh
authors: Roger G
authors: RG
authors: Evans
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D010349:Patient Compliance; D010351:Patient Discharge / Q000706:statistics & numerical data*; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D016019:Survival Analysis; D017741:Survivors; D014739:Victoria / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: epidemiology; medication adherence; risk factors; secondary prevention