| Background:Cerebrovascular disease has become an important cause of death and disability in our cities and rural areas currently. The incidence of cerebrovascular disease increase year by year. In our existing subtypes of diseases, about 70% of patients were diagnosed with ischemic stroke and most of them accompanied with multiple risk factors. They are at high risk of recurrent of stroke. According to the latest data, the annual rate of recurrence stroke was 17.7%. Considering of the factors of age growth, upgrades of our economic level and negative lifestyles, the morbidity of ischemic stroke increases significantly, which implies the increase of both atherosclerosis-based ischemic cerebrovascular diseases (including transient ischemic attack).Patients suffered from stroke and transient ischemic attacks are at high risk of recurrent stroke with approximately 15% to 42% in five years. In all patients with stroke, the rate of recurrent stroke can reach 40%. Moreover, those patients have not only higher mortality rate of recurrent stroke but worse functional recovery.Secondary prevention, commonly known as pre-clinical prevention (or pre-symptomatic), requires early detection, early diagnosis and early treatment. With those approaches, we may palliate the progress of disease and reduce or even avoid the incidence of complications, sequelae and life-dependency. Patients who combine drugs with lifestyle changes in secondary prevention of stroke can reduce 80% rate of recurrent vascular events in five years. For drugs used in ischemic stroke and transient ischemic attack, both Chinese and abroad guidelines have give advices.In 2014, the American Heart Association (AHA) and American Stroke Association (ASA) jointly developed the latest version of secondary prevention guidelines for stroke and transient ischemic attack. China has given emphasis to the prevention and treatment of stroke. Hence, the nerve branch of Chinese Medical Association compiled the guidelines of secondary prevention for ischemic stroke and transient ischemic attack in China in the same year. By refer to studies from domestic to overseas and in accordance of Chinese people’s actual condition, they compiled guidelines of secondary prevention for ischemic stroke and transient ischemic attack according to Chinese national condition. These guidelines play an important role in the secondary prevention of ischemic stroke and transient ischemic attack.Compliance, also known as adherence, refer to the patients comply with treatment prescribed by their doctors and behavior consistent with the doctor’s advice. In other word, we can say patient " cooperation ". On the contrary, we claimed them non-compliance. Compliance can be divided into three degrees:fully compliant, partially compliant (over or under—dosing medication, increasing or decreasing the number of drugs, etc.) and full noncompliance. Compl iance can be assessed in many ways. Up to now, different studies using different methods. In generally, self-reported adherence assessment combined with counting pills or drug —related electronic monitor is a convincing research method.From domestic and foreign researches, we can see that it is a common problem in the secondary prevention medication compliance. It can be influenced by many factors. More importantly, these studies have shown that higher medication compliance of patients were prone to have more positive outcomes. At the same time, their function and prognosis were significantly better than the non-compliance patients.Secondary prevention of ischemic stroke and transient ischemic attack is particularly important. However, the effective implementation of secondary prevention is closely related to patients’s compliance. Even doctors have prescript for patients, patients may not take the medicine as required. This may influence by the concept of the patient, the financial situation, medical insurance and many other reasons. Poor compliance will largely affect the secondary prevention effects as a result. Therefore, improving the compliance of secondary prevention medication in patients who diagnosed with ischemic stroke or transient ischemic attack, can effectively improve patient outcomes.At present, the majority of studies discussed the compliance of medication in the secondary prevention of stroke focused on various factors on compliance.However, they are lack of research which assesse separately for each medication compliance and related outcomes, or combine the compliance with drug efficacy.Objective:In ischemic stroke and transient ischemic attack disease, medication compliance is essential for effective secondary prevention. In this study, we survey from May 2015 to November 2015 in hospital in Guangzhou, Guangdong Province. We included patients with a history of ischemic stroke and transient ischemic attack patients in five years. The main purpose of this study:1. Through a questionnaire, we get the details of medicine that patients who were diagnosed with ischemic stroke and transient ischemic attack. Use the MMAS-8 to evaluate the situation of medication compliance;2. Discuss the factors that may influence adherence to secondary prevention drugs;3. Get the blood pressure and blood-related indicators at the time of admission and explore if compliance of medicine may associate with the relevant indicators;4. Analyze the cases of recurrent ischemic stroke or transient ischemic attack in patients after the onset of medication. Then, we discuss the relationship between the recurrent stroke (or transient ischemic attack or new stroke) and the compliance of medicine;5. Combined with the degree of patient compliance, we investigate the efficacy in the use of lipid-lowering and antithrombotic drugs in patients with good compliance. Discuss if the use of medicines related to the recurrent ischemic stroke or transient ischemic attack or new stroke. It may provide a theoretical basis and foundation for further multi-center cohort study, and provide a basis for the effective implementation of ischemic stroke and transient ischemic attack standardization of secondary prevention measures.Methods:The survey was conducted from May 2015 to November 2015 in Hospital, Guangzhou, Guangdong Province. Patients used to diagnosed with ischemic stroke or transient ischemic attack within five years were included in our study. Then, we screened their situation. If they meet the inclusion criteria, we got them into our research. The questionnaire and detailed records of the relevant information were survey. Investigators asked patients and their families respectively, to confirm drug cases, drug list or to obtain a prescription before the admission after the first IS or TIA. At the same time, we used the MM AS — 8 to assess the compliance of all types of drug treatment one by one. What’s more, according to medical records in the five years, or reported by their families, we got to know the situation of patients during these days, and determined whether they suffered from recurrent ischemic stroke or transient ischemic attack or new stroke during the treatment. The data obtained were analyzed by SPSS 19.0 statistical software package. The main purposes of this study are:Through a questionnaire, we get the details of medicine that patients who were diagnosed with ischemic stroke and transient ischemic attack. Use the MMAS-8 to evaluate the situation of medication compliance; Discuss the factors that may influence adherence to secondary prevention drugs; Get the blood pressure and blood-related indicators at the time of admission and investigate if compliance of medicine may associate with the relevant indicators. Analyze the cases of recurrent ischemic stroke or transient ischemic attack in patients after the onset of medication. Then, we discuss the relationship between the recurrent stroke (or transient ischemic attack or new stroke) and the compliance of medicine. Combined with the degree of patient compliance, we investigate the efficacy in the use of lipid-lowering and antithrombotic drugs in patients with good compliance. Discuss if the use of medicines related to the recurrent ischemic stroke or transient ischemic attack or new stroke.Results:In our hospital, we got 381 cases with previous diagnosed with ischemic stroke or transient ischemic attack patients which completed information and can be followed up.1. The minimum age is 32 years old. The maximum age is 97 years old. in these patients, high compliance are 123 (32.3%) patients, medium compliance are 86 (22.6%) patients, low compliance are 172 (45.1%) patients. In the antithrombotic drugs and lipid-lowering drugs, doctors prescribe rates were 89.7 %,71.9%, respectively. In the patients with the above two kinds of medication, good compliance were accounted for 56.4%,56.9%, respectly. In the patients who were diagnosd with hypertension and diabetes, doctors prescribe rates of antihypertensive drugs and hypoglycemic agents were 95.6% and 86.5%. In patients with the above two medication, good compliance of patients accounted for 56.1% and 57.7%. To put it simply, in patients with antithrombotic drugs and lipid-lowering drugs, medicine taken regularly accounted for 50.6% and 40.9% of all patients, respectively. In patients who diagnosed of hypertension and diabetes, antihypertensive drugs and hypoglycemic were accounted for 53.6% and 49.9%, respectively. In the use of antihypertensive drugs, hypoglycemic, lipid-lowering drugs and anticoagulants, the compliance of patients were not significantly different. However, in the use of antiplatelet drugs, and the use of Chinese medicine, the difference of compliance in patients was statistically significant. In long term use of antiplatelet drugs, the patient medication compliance was higher. As the same result, the long-term use of drugs in Chinese medicine, patient compliance was higher.2. Adopted the potential factors for multiple linear regression analysis. Compliance-related factors include marital status and cost of the drugs (P <0.05). Compared the patients who were married with who were unmarried, divorced or widowed, their compliance were relatively higher. The compliance of patients whose drugs cost below 500 Yuan a month was relatively lower.3. At patient’s admission, we got the blood pressure of each patient. The next day, blood samples were taken to analyze the index of correlation. In the patients of different level of compliance, systolic blood pressure, fasting glucose, triglyceride were not statistically different. However, the total cholesterol and low density lipoprotein show statistics difference. High compliance group compared with low compliance group, the total cholesterol (P = 0.001) and low density lipoprotein (P= 0.000) indicators were relatively lower. This result indicates that drug compliance has a significant influence on serum lipids.4. The outcomes of our patients were set as recurrent ischemic stroke, recurrent transient ischemic attack and previous transient ischemic attack in patients with new onset of stroke in the long-term use of medication. It is also known as a positive event. Among them, the rate of recurrent transient ischemic attack and previous transient ischemic attack in patients with new onset of stroke was not statistically different in the difference level of compliance. However, the rate of recurrence of ischemic stroke in different level of compliance was statistically significant difference. With lower compliance, patients may undertake the higher incidence of recurrent ischemic stroke.5. We make an efficacy evaluation on lipid — lowering drugs and antithrombotic drugs. However, poor compliance in patients who use antihypertensive drugs and hypoglycemic agents may affect our drug efficacy evaluation. In order to exclude this error, patients with total poor compliance of all drugs were excluded. In the present study, the patients with good compliance were 209. According to the measurement of MMAS-8, these patients can be judged to compliance. In these patients, we found that whether use lipid-lowering drugs (P= 0.000), or use antithrombotic drugs (P= 0.001), or use combined lipid-lowering drugs and antithrombotic drugs (P= 0.000), compared to the corresponding control group, differences were statistically significant. It can be consider that the lipid-lowering drugs and the antithrombotic can decrease the incidence of recurrent ischemic stroke or transient ischemic attack or previous transient ischemic attack in patients with new onset of stroke. However, when compared the lipid-lowering drug alone group with the antithrombotic drug alone group and with combined lipid-lowering drugs and antithrombotic drugs group, the positive rates of event in the three groups were not statistically significant.Conclusion:In summary, in the drugs of secondary prevention, the use of lipid-lowering drugs and antithrombotic drugs can effectively reduce the incidence of recurrent ischemic stroke or transient ischemic attack or previous transient ischemic attack in patients with new onset of stroke. However, secondary prevention medication in the patients suffered from ischemic stroke and transient ischemic attack were not reach the standard. The problem of poor adherence is very common. We need to strengthen the education and training in physician on the secondary prevention of ischemic stroke. What’smore, we should make more effort to propagate the information of related diseases and medication to patients and their families. Only in this way, can we reinforce the motivation of patients to take medication and let the families to better supervise the patients to take medication. However, the present study is a retrospective study and a single-center study. The representation of space and temporality is insufficient. It still needs further perceptiveness study of multi-center which may has larger samples. |
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