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

Abstract

Secondary prevention; Ischemic stroke; Atrial fibrillation

Prevención secundaria; Ictus isquémico; Fibrilación auricular

Prevenció secundària; Ictus isquèmic; Fibril·lació auricular

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).

This work was partially supported by the grant RD21/0016/0006 Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), funded by the Carlos III Health Institute (ISCIII), Ministry of Science, Innovation and Universities, and the Recovery, Transformation and Resilience Plan through NextGenerationEU European funds. In addition, Clara Rodriguez-Bernal was funded through a competitive grant (Sara Borrell CD19/00137). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health or the study sponsors.