Association Between Optimal Combination Pharmacotherapy and Survival After Stroke: A Registry and Pharmaceutical Dispensing Study

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Monique F Kilkenny
Lachlan L Dalli
Joosup Kim
Nadine E Andrew
Frank M Sanfilippo
Vijaya Sundararajan
Helen M Dewey
Rohan Grimley
Amanda G Thrift
Dominique A Cadilhac


To prevent further vascular events, prescribing of multiple classes of medications (antihypertensive, antithrombotic and lipid-lowering) is recommended in national clinical guidelines following ischaemic stroke.

Objectives and Approach
Using real-world data, we determined the association between optimal combination pharmacotherapy (supply of all three classes, “optimal pharmacotherapy”) and survival after stroke. We linked a cohort of patients with first-ever ischaemic stroke from the Australian Stroke Clinical Registry (2010-2014) with national pharmaceutical dispensing and national mortality data. Cox regression was used to determine associations between pharmacotherapy in the first 30 days of stroke with 1-year (from day 31 to 395) all-cause mortality. All analyses were adjusted for socio-demographic (age, sex) and clinical characteristics (stroke severity, discharge destination).

Among 6684 patients discharged following first-ever ischaemic stroke (median length-of-stay 5 days), 6466 patients who survived to 30 days were included (44% female, median age 74 years). During the first 30 days from discharge, 71.4% received ≥1 medication class, and 32.9% (n=2125) received optimal pharmacotherapy. Patients with optimal pharmacotherapy were older (≥75 years 50.3% vs <75 years 44.5%; p<0.001), discharged directly home (home 58.5% vs other 40.3%; p<0.001) and experienced a less severe stroke (able to walk on admission 46.9% vs 36.4%; p<0.001), than those without optimal pharmacotherapy. Between day 31 and 395, there were 667 deaths; 530 related to cardiovascular disease. Compared to no medication, treatment with two medications was associated with a 42% lower risk of death (hazard ratio [HR]: 0.58; 95%CI: 0.45-0.73); and optimal pharmacotherapy had a 62% lower risk of death (HR: 0.38; 95% CI: 0.31-0.47). Survival was similar between those with one or no medication.

Conclusion / Implications
Patients with ischaemic stroke who received optimal pharmacotherapy within 30-days of admission had greater one-year-survival. Further research is required to understand reasons for sub-optimal pharmacotherapy in these patients.

Article Details

How to Cite
Kilkenny, M. F., Dalli, L. L., Kim, J., Andrew, N. E., Sanfilippo, F. M., Sundararajan, V., Dewey, H. M., Grimley, R., Thrift, A. G. and Cadilhac, D. A. (2020) “Association Between Optimal Combination Pharmacotherapy and Survival After Stroke: A Registry and Pharmaceutical Dispensing Study”, International Journal of Population Data Science, 5(5). doi: 10.23889/ijpds.v5i5.1497.

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