An Assessment of Patients Factors Effect on Prescriber Adherence to Ischemic Stroke Secondary Prevention Guidelines

Abstract

Background:: Stroke is the leading cause of long-term disability worldwide. Stroke recurrence is a major health problem with devastating consequences. Adherence to secondary prevention guidelines reduced stroke recurrence. Data regarding prescriptions adherence to secondary prevention guidelines in the Middle East and North Africa is lacking. Objectives: the aim of this study is to assess the degree of physician adherence to ASA guidelines and the patient specific factors that affects their prescribing patterns in a major teaching hospital in Jordan. Method: Ischemic stroke patients referring to King Abdullah University Hospital were approached and offered a description of the study to obtain their informed consent. After getting the informed consent, their prescription at the time of discharge were evaluated for adherence to secondary prevention guidelines and classified into adherent and non-adherent based on a composite score that included each of the guidelines indicated therapeutic classes. Odds ratio for adherence and their 95%confidence intervals were calculated and adherence to specific therapeutics classes was evaluated. Results: Two hundred and seventy-five patients were included in this evaluation. Less than 50% of the patients received guideline’s adherent prescriptions. Patients with hypertension and hyperlipidemia were associated with a lower probability to be prescribed a guidelines adherent regimen (OR 0.485, 0.0.225, respectively). ACEI/ARBs combination with thiazides was prescribed to about 11.52% of the patients. Conclusion: Adherence to stroke secondary prevention guidelines was suboptimal especially in the antihypertensive prescription component. Further assessments and evaluations are required improve guidelines adherence.

Blood Pressure Control and Prescription Pattern of Antihypertensive Drugs in Adherence to the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines in Saudi Arabia: A Retrospective Study

“…In our study, the most preferred choice among stroke patients were RAS blockers (92.3%) and DHP-CCBs (69.2%). Our results align with the hypertension guidelines [8,9] and the results of a previous study conducted in Jordan [24]. RAS blockers, βblockers, and diuretics improve clinical outcomes in patients with HF [9].…”

Evaluation of Physicians’ Compliance With Secondary Prevention Among Ischemic Stroke Patients: A Retrospective Study

“…However, there was no documentation behind not recommending antiplatelets for the rest of the patients. A similar study found that 32 out of 275 stroke patients were discharged with no antiplatelet therapy [ 9 ]. In addition, the guideline recommended that DAPT should not exceed 90 days and should not be combined with anticoagulant medication, as recent trials have shown that there is no benefit over single antiplatelet therapy to reduce recurrent stroke, in addition to increasing the risk of major bleeding and intracerebral hemorrhagic stroke [ 11 , 12 ].…”

“…Several studies have shown an increase in the rehospitalization rate among IS patients caused by not adhering to the guideline recommendations for secondary stroke prevention. Studies have found a decline in the rehospitalization rate of stroke patients as they followed the guideline recommendations [6][7][8][9][10]. According to a retrospective cohort study, patients who were discharged after IS with secondary stroke prevention therapies in the short and long term will help reduce the risk of recurrent stroke [10].…”