XVII. European Stroke Conference
Nice, France

Oral Session:

Management and economics
Date: Wednesday 14 May 2008  
Time: 9:10 - 9:20 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

01
Adherence to secondary prevention one year after stroke. A nation-wide follow-up study.
F. Glader    M. Lundberg    M. Eriksson    K. Hulter-Åsberg    B. Norrving    B. Stegmayr    A. Terént    K. Asplund              
 

Umeå University Hospital

SWEDEN

Background There is little information on long-term adherence to secondary prevention after stroke. The objective of this study is to describe the adherence to secondary preventive drugs after stroke during the first year after discharge from hospital. Methods This study is based on Riks-Stroke, the Swedish national quality register for stroke care. In total 11 077 stroke patients who were discharged from hospital during the last six months of 2005 were included. Information on antihypertensive drugs, statins and antithrombotic drugs at discharge was assessed from Riks-Stroke and data on dispensed drugs during one year after discharge from hospital was assessed from the national prescription database at the National Board of Health and Welfare. Results The mean age of included patients was 76 years and 49.3 percent were women. During the first 4 months after discharge from hospital, 86.1% of patients with cerebral infarction who had been discharged with an antiplatelet agent had a prescription that had been dispensed by a pharmacy. The figure for all stroke patients was for statins 84.1% and for hypertensive agents; ACE-inhibitors or angiotensin receptor blockers (ARBs) 83.7%, beta-blockers 83.1%, calcium-blockers 80.5% and diuretics 77.5%. One year after discharge the adherence for antiplatelet agents among patients with cerebral infarction was 67.7%. The one-year adherence for statins was 59.8% and for hypertensive agents; ACE-inhibitors or ARBs 62.4%, beta-blockers 60.7%, calcium-blockers 56.5% and diuretics 55.0%. At one year after stroke, men had more often stopped taking diuretics, beta-blockers, calcium-blockers, statins and antiplatelet agents compared to women. Discussion This nation-wide study of adherence to secondary prevention shows that many patients did not start taking prescribed preventive drugs after stroke and even less did continue at one year after discharge. To be able to lower stroke recurrences and other cardiovascular events, interventions are needed to optimise adherence to long-term preventive treatment.

Management and economics
Date: Wednesday 14 May 2008  
Time: 9:20 - 9:30 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

02
The cost-effectiveness of a program to improve control of blood pressure in general practice settings and prevent stroke: an example from Australia.
D.A.Cadilhac    R.C.Carter    A.G.Thrift    H.M.Dewey                                          
 

National Stroke Research Institute

AUSTRALIA

Background: High blood pressure (BP) is the most important modifiable risk factor for stroke. Control of BP is inadequate in a number of countries. In Australia, 60% of people receiving treatment for high BP are uncontrolled. The aim of this study was to assess whether a program of organised multidisciplinary care with regular follow-up and medication would be cost-effective for improving BP control as both primary and secondary prevention of stroke. Methods: The incremental difference between current practice and the intervention was assessed as the net cost per Quality Adjusted Life Year (QALY) gained. Cost-effectiveness was defined as a cost/QALY gained of <AUD$50,000. A societal perspective was nominated. Results are provided for a 2004 reference year. Incident cases of stroke prevented contributed lifetime benefits and cost-offsets. For recurrent stroke events, cost-offsets were counted for only one-year. Multivariate probabilistic uncertainty analysis (6,000 model simulations) was used to assess the robustness of estimates. Results: Organised care was cost-effective for ‘high risk’ populations. For primary prevention, in people aged 75+, the median cost/QALY gained was AUD$11,068 (95% uncertainty interval [UI] AUD$5,201 to AUD$18,696), while in those aged 55 to 84 years with a 15% ‘absolute risk’ of stroke the median cost/QALY gained was AUD$17,359 (95% UI AUD$10,516 to AUD$26,036). The median cost per QALY gained for secondary prevention was between AUD$1,811 and AUD$4,704 depending on the medications used. Interventions for people aged below 50 years were not cost-effective. Conclusions: Organised care for BP control targeted at specific ‘high risk’ populations offer excellent value over current practice and should be implemented to reduce stroke occurrences.

Management and economics
Date: Wednesday 14 May 2008  
Time: 9:30 - 9:40 -  Room: Euterpe
Chair: I. Henriques, Portugal and D.W.J. Dippel, The Netherlands

03
Effectiveness of statin treatment in patients with a recent TIA or ischemic stroke: results from the Netherlands Stroke Survey.
H.F.Lingsma    D.W.J.Dippel    E.W.Steyerberg    R. van Domburg    W.J.M.Scholte op Reimer                                   
 

Erasmus University

THE NETHERLANDS

Aim and background The benefit of statins in patients with acute ischemic stroke or TIA has been demonstrated in RCT’s. Effectiveness in daily practice may however be violated by a different patient population and less patient compliance. We describe statin use and compliance, identify factors related to statin use and assess the effect of statins on outcome in The Netherlands Stroke Survey, an unselected patient cohort. Methods In 2003, in 10 centers in the Netherlands, patients admitted to the hospital or visiting the outpatient clinic with a recent TIA or ischemic stroke were prospectively and consecutively enrolled. Main outcome was the occurrence of vascular events (mortality, stroke or MI) within 3 years. Statin use was defined as statin use at discharge. We constructed a propensity score to adjust for patient characteristics related to statin use. We used logistic regression models to estimate the propensity score adjusted effect of statins on outcome. We performed sensitivity analysis by excluding patients who were already using statins prior to their stroke. Results Patients who died during admission (n=62) were excluded. Of the remaining 751 patients, 262 (35%) had experienced a vascular event within 3 years. Age, hospital admission, ischemic heart disease, hypertension, lowered consciousness level, BMI ³25 and elevated cholesterol levels were associated with statin use. Propensity score adjusted analyses showed a beneficial effect of statins on the occurrence of vascular events (odds ratio:0.80, 95%CI:0.56-1.14). In patients without statins prior to their stroke (n=622) the odds ratio was 0.61 (95%CI:0.38-0.79). Conclusion The effect of statins on the occurrence of vascular events within 3 years in this study is similar to the effect observed in RCT's.