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. 2024 Dec 30;14(1):31596.
doi: 10.1038/s41598-024-79961-4.

Untangling areas of improvement in secondary prevention of ischemic stroke in patients with atrial fibrillation

F Sánchez-Sáez  1   2 , C L Rodríguez-Bernal  3   4 , I Hurtado  1   2 , J Riera-Arnau  5 , A Garcia-Sempere  1   2 , Salvador Peiró  1   2 , G Sanfélix-Gimeno  1   2
Affiliations

Untangling areas of improvement in secondary prevention of ischemic stroke in patients with atrial fibrillation

F Sánchez-Sáez et al. Sci Rep. .

Abstract

Improvement of post-stroke outcomes relies on patient adherence and appropriate therapy maintenance by physicians. However, comprehensive evaluation of these factors is often overlooked. This study assesses secondary stroke prevention by differentiating patient adherence to antithrombotic treatments (ATT) from physician-initiated interruptions or switches. We analyzed a population-based retrospective cohort (n = 10,343) of post-stroke patients with atrial fibrillation using the VID database (2010-2017). Secondary prevention was evaluated based on patients' primary and secondary adherence to ATT at two years (percentage of days covered-PDC-and persistence/discontinuation) and physician prescription patterns (initiation, interruption, switching, restart). E-prescription and dispensing data were linked. Three ATT strategies were identified: oral anticoagulants (OAC), antiplatelets (APT), or combination therapy (OAC + APT), prescribed to 54%, 23%, and 17% of patients, respectively. Primary adherence was high for all ATTs (≈90%). OAC discontinuation was highest (16%), but frequently restarted (73.4%). APT treatment was interrupted the most (14%) and restarted the least (38.5%) by physicians, followed by OAC (interrupted in 11%, restarted in 65%). Overall, 17% of patients switched treatments, with OAC + APT being switched the most (76%), mainly to OAC (53.8%). Identifying areas for improvement in secondary stroke prevention requires considering both patient adherence and physician prescription patterns (initiation, interruptions, and restarts).

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population flowchart.
Fig. 2
Fig. 2
Antithrombotic treatment switching, physician interruption and patient discontinuation within 2 years after stroke.
Fig. 3
Fig. 3
Kaplan–Meier curves for physician interruption of treatment and patient discontinuation.
See this image and copyright information in PMC

References

    1. Wang, H. et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet388, 1459–1544. 10.1016/S0140-6736(16)31012-1 (2016). - PMC - PubMed
    1. Murray, C. J. L. et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet380, 2197–2223. 10.1016/S0140-6736(12)61689-4 (2012). - PubMed
    1. Rothwell, P. M. et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet363, 1925–1933. 10.1016/S0140-6736(04)16405-2 (2004). - PubMed
    1. Freedman, B., Potpara, T. S. & Lip, G. Y. H. Stroke prevention in atrial fibrillation. Lancet388, 806–817. 10.1016/S0140-6736(16)31257-0 (2016). - PubMed
    1. Klijn, C. J. et al. Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: A European Stroke Organisation guideline. Eur. Stroke J.4, 198–223. 10.1177/2396987319841187 (2019). - PMC - PubMed

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