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Title: Disparities in Antihypertensive Prescribing After Stroke: Linked Data From the Australian Stroke Clinical Registry.
Austin Authors: Dalli, Lachlan L;Kim, Joosup;Thrift, Amanda G;Andrew, Nadine E;Lannin, Natasha A;Anderson, Craig S;Grimley, Rohan;Katzenellenbogen, Judith M;Boyd, James;Lindley, Richard I;Pollack, Michael;Jude, Martin;Durairaj, Ramesh;Shah, Darshan;Cadilhac, Dominique A;Kilkenny, Monique F
Affiliation: Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
Peninsula Clinical School, Central Clinical School, Monash University, Clayton, VIC, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourn, VIC, Australia
School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
The University of Sydney, NSW, Australia
Wagga Wagga Hospital, NSW, Australia
Cairns Base Hospital, QLD, Australia
Princess Alexandra Hospital, Brisbane, QLD, Australia
The George Institute for Global Health, Sydney, NSW, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Hunter Stroke Service, Hunter New England Health, NSW, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Australia
Sunshine Coast Clinical School, University of Queensland, Birtinya, QLD, Australia
Royal Prince Alfred Hospital, Camperdown, NSW, Australia
The George Institute for Global Health at Peking University Health Science Center, China
Issue Date: Dec-2019 2019-10-25
Publication information: Stroke 2019; 50(12): 3592-3599
Abstract: Background and Purpose- Despite evidence to support the prescription of antihypertensive medications before hospital discharge to promote medication adherence and prevent recurrent events, many patients with stroke miss out on these medications at discharge. We aimed to examine patient, clinical, and system-level differences in the prescription of antihypertensive medications at hospital discharge after stroke. Methods- Adults with acute ischemic stroke or intracerebral hemorrhage alive at discharge were included (years 2009-2013) from 39 hospitals participating in the Australian Stroke Clinical Registry. Patient comorbidities were identified using the International Statistical Classification of Diseases and Related Health Problems (Tenth Edition, Australian Modification) codes from the hospital admissions and emergency presentation data. The outcome variable and other system factors were derived from the Australian Stroke Clinical Registry dataset. Multivariable, multilevel logistic regression was used to examine factors associated with the prescription of antihypertensive medications at hospital discharge. Results- Of the 10 315 patients included, 79.0% (intracerebral hemorrhage, 74.1%; acute ischemic stroke, 79.8%) were prescribed antihypertensive medications at discharge. Prescription varied between hospital sites, with 6 sites >2 SDs below the national average for provision of antihypertensives at discharge. Prescription was also independently associated with patient and clinical factors including history of hypertension, diabetes mellitus, management in an acute stroke unit, and discharge to rehabilitation. In patients with acute ischemic stroke, females (odds ratio, 0.85; 95% CI, 0.76-0.94), those who had greater stroke severity (odds ratio, 0.81; 95% CI 0.72-0.92), or dementia (odds ratio, 0.65; 95% CI, 0.52-0.81) were less likely to be prescribed. Conclusions- Prescription of antihypertensive medications poststroke varies between hospitals and according to patient factors including age, sex, stroke severity, and comorbidity profile. Implementation of targeted quality improvement initiatives at local hospitals may help to reduce the variation in prescription observed.
DOI: 10.1161/STROKEAHA.119.026823
ORCID: 0000-0001-8162-682X
Journal: Stroke
PubMed URL: 31648630
Type: Journal Article
Subjects: blood pressure
medication adherence
risk factor
Appears in Collections:Journal articles

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