Non-persistence in ischemic stroke patients and the risk of recurrent vascular events.

Rijkmans, M.J. (2013) Non-persistence in ischemic stroke patients and the risk of recurrent vascular events. thesis, Medicine.

Text RijkmansMJ.pdf Restricted to Registered users only Download (613kB)

Abstract

Introduction: Stroke causes 9% of all deaths worldwide and is the third most common cause of death after ischemic heart disease and lung cancer. Ischemic stroke is an expression of underlying vascular disease. Patients who suffered an ischemic stroke have a risk of a vascular event (myocardial infarction, recurrent stroke or vascular death), ranging from 9 to 18% each year. Although the secondary prevention strategies are supposed to be continued for life, medication use commonly declines in time. This may lead to stroke recurrence, disability, and death. Persistence is defined as continuing medical treatment. Until now there has been no study, linking the persistence of secondary prevention medication with the risk of a vascular event (including recurrent ischemic stroke) after an ischemic stroke. The hypothesis of this study is: Non-persistence in stroke patients increases the risk of recurrent vascular events. Material & methods: This is a retrospective cohort study based on patients originally registered for research on the administration of alteplase, acute treatment in ischemic stroke. The study was conducted within the Isala Klinieken in Zwolle, the Netherlands. Inclusion criteria were acute ischemic stroke, survival for at least 2 months and a score of 3 or less on the modified Rankin Scale. The medical history until the moment of the index ischemic stroke was investigated and relevant items were registered. The secondary preventive medications prescribed by the neurologist were listed, containing: aspirin, dipyridamole, perindopril, statins and sintrom. For each regimen was reported if it was used at hospital discharge and if the patients had taken it until the moment of follow-up or death. Two groups were formed; the group persistent with secondary prevention treatment as established at hospital discharge from index ischemic stroke and the group that was not persistent. Primary endpoint were vascular events, secondary endpoints were ischemic stroke and mortality. Differences between the two groups were compared using the Chi-Square test and Mann-Whitney U test for categorical and not-normally distributed variables, respectively. A Kaplan-Meier survival analysis was used for comparing the event free survival between the groups. The overall significance level for the study was a P value of <0.05, using a 2-sided test. Data were analyzed using SPSS20.0 Results: A total of 212 patients were included in the study, who were admitted to the hospital between January 2007 and July 2008. The persistent group contained 124 patients, and the non-persistent group 73. No accurate information on persistence of medication was available in 15 patients. In the persistent group 17,7% had a primary endpoint, versus 19,2% in the non-persistent group (P=0.801). For ischemic stroke this was 12,1% in the persistent group versus 15,0% in the non-persistence group (P=0.552). Mortality was 25,0% in the persistent and 15,0% in the not-persistent group (P=0.100). After stratifying for vascular risk factors in the medical history, in the group with more risk factors persistence was significantly associated with a lower stroke incidence; 17,5% versus 39,1% (P=0.035). Conclusion: In this study being persistent with secondary prevention medication, started by a neurologist after ischemic stroke, is associated with a relatively lower risk on a recurrent ischemic stroke in patients who already have vascular risk factors in their medical history.

Item Type:	Thesis (Thesis)
Supervisor name:	Berg, dr. JSP van den and Isala Klinieken, Zwolle
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1690

Actions (login required)

View Item