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Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study

Journal article
Authors L. Ingrid
M. von Euler
Katharina Stibrant Sunnerhagen
Published in BMJ Open
Volume 10
Issue 3
Pages 9
ISSN 2044-6055
Publication year 2020
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Pages 9
Language en
Links dx.doi.org/10.1136/bmjopen-2019-036...
Keywords length-of-stay, atrial-fibrillation, risk-factors, severity, population, warfarin, aspirin, pretreatment, validation, derivation, General & Internal Medicine
Subject categories Neurosciences

Abstract

Objective The objective was to investigate if there is a relationship between preischaemic stroke medicine use and health outcomes after stroke. Setting This registry-based study covered Swedish stroke care, both primary and secondary care, including approximately 60% of the Swedish stroke cases from seven Swedish regions. Participants The Sveus research database was used, including 35 913 patients (33 943 with full information on confounding factors) with an ischaemic stroke (International Classification of Diseases, 10th Revision (ICD-10) I63*) between 2009 and 2011 registered both in the regions' patient administrative systems and in the Swedish Stroke Register. Patients with haemorrhagic stroke (ICD-10 I61*) were excluded. Primary outcome The primary outcome was the association, expressed in ORs, of prestroke medicine use (oral anticoagulants, statins, antihypertensives, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs) and antidiabetic drugs) and health outcomes 1 and 2 years poststroke (survival, activities of daily living dependency and modified Rankin Scale (mRS) 0-2), adjusted for patient characteristics and stroke severity at stroke onset. Results The multivariate analysis indicated that patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants prestroke had worse odds for health outcomes in both survival (OR 0.65, 95% CI 0.60 to 0.69; OR 0.77, 95% CI 0.71 to 0.83; OR 0.72, 95% CI 0.66 to 0.80; OR 0.91, 95% CI 0.84 to 0.98, respectively, for survival at 2 years) and functional outcome (OR 0.82, 95% CI 0.75 to 0.89; OR 0.61, 95% CI 0.55 to 0.68; OR 0.83, 95% CI 0.72 to 0.95; OR 0.58, 95% CI 0.52 to 0.65, respectively, for mRS 0-2 at 1 year), whereas patients on statins and NSAIDS had significantly better odds for survival (OR 1.16, 95% CI 1.08 to 1.25 and OR 1.12, 95% CI 1.00 to 1.25 for 1-year survival, respectively), compared with patients without these treatments prior to stroke. Conclusions The results indicated that there are differences in health outcomes between patients who had different common prestroke treatments, patients on drugs for hypertension, diabetes, oral anticoagulants and antidepressants had worse health outcomes, whereas patients on statins and NSAIDS had significantly better survival, compared with patients without these treatments prior to stroke.

Page Manager: Webmaster|Last update: 9/11/2012
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