Presenter of 2 Presentations
USE OF LIPID-LOWERING MEDICATIONS AFTER DISCHARGE FOR ISCHAEMIC STROKE AND THE ASSOCIATION WITH MORTALITY AND HOSPITAL READMISSIONS
Abstract
Background and Aims
Lipid-lowering medications (LLMs) are recommended for secondary prevention of stroke. Little is known about the association between their ongoing use post-discharge and outcomes. We investigated the use and adherence to LLMs within the first 90 days post-discharge for ischaemic stroke and associated 12-month outcomes.
Methods
Retrospective cohort study of 90-day survivors of ischaemic stroke from hospitals (n=45) in two Australian states participating in the Australian Stroke Clinical Registry (2012-2016). Person-level data were linked with Pharmaceutical Benefits Scheme (PBS), hospital and death datasets. LLM use within 90 days post-discharge was determined from PBS dispensing records. Among users, adherence was assessed using the proportion of days covered (PDC: <80% vs. ≥80%) within 90 days post-discharge. Outcomes during the subsequent year (91-455 days) included all-cause mortality and hospital readmissions (cardiovascular disease, all-cause). Associations between use/adherence and outcomes were determined using propensity score adjusted-multivariable Cox regression models.
Results
Of 11,217 eligible patients (median age 72 years, 42% female), 9,294 (83%) used LLMs within 90 days post-discharge, including 5,938 (64%) with PDC ≥80%. Compared to users, non-users, had greater rates of mortality [hazard ratio (HR) 2.35, 95% CI 1.89-2.93] or all-cause readmissions (HR 1.16, CI 1.09-1.22). Among users, those with PDC <80% had greater rates of mortality (HR 1.31, CI 1.14-1.51) or all-cause readmissions (HR 1.05, CI 1.00-1.09) than those with PDC ≥80%. There were no associations between use/adherence and cardiovascular disease readmissions.
Conclusions
Use and greater adherence to LLMs (90-days) for ischaemic stroke is associated with reduced all-cause mortality and readmissions.
ASSOCIATION BETWEEN USE OF LIPID-LOWERING MEDICATIONS AFTER DISCHARGE FOR ISCHAEMIC STROKE AND LONG-TERM QUALITY OF LIFE
Abstract
Background and Aims
It is unclear whether treatment with lipid-lowering medications (LLMs) affects health-related quality of life (HRQoL) after stroke. We evaluated the association between 90-day use and adherence to LLMs after hospital discharge for ischaemic stroke and HRQoL.
Methods
Retrospective cohort study of 90-day survivors of ischaemic stroke admitted to hospitals in Victoria and Queensland participating in the Australian Stroke Clinical Registry (2012-2016). Use and adherence to LLMs were determined through linkage of patient-level data with the Pharmaceutical Benefits Scheme. Adherence to LLMs in the first 90 days post-discharge was calculated as the proportion of days covered (PDC: <80% vs. ≥80% [greater adherence]). The EQ-5D-3L questionnaire was administered to registrants between 90-180 days from hospital admission date to assess self-reported HRQoL overall and across five health domains. Cross-sectional associations between use/adherence and HRQoL outcomes were determined using multivariable regression models.
Results
Of 6,780 eligible registrants (median age 72 years, 42% female), 5,816 (86%) used LLMs in 90 days post-discharge, including 3,838 (66%) with PDC ≥80%. Compared to users, non-users were at significantly greater odds of reporting problems in each health domain: mobility (odds ratio 1.40), self-care (1.81), usual activities (1.26), pain/discomfort (1.19), and anxiety/depression (1.39). Non-use of LLMs was also associated with poorer overall HRQoL (-5.00, 95% CI -7.27, -2.73). Among users, having a PDC <80% was associated with reporting problems in each health domain and poorer overall HRQoL.
Conclusions
Use and greater adherence to LLMs post-discharge for ischaemic stroke is associated with better HRQoL outcomes.