High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA.
Lane, Dan Beishon, Lucy Sharma, Vinoda Salim, Farah Sze, Shirley Timmins, Matthew A Robinson, Thompson Eveson, David Mistri, Amit Patel, Prashanth
Lane, Dan
Beishon, Lucy
Sharma, Vinoda
Salim, Farah
Sze, Shirley
Timmins, Matthew A
Robinson, Thompson
Eveson, David
Mistri, Amit
Patel, Prashanth
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Affiliation
University Hospitals of Leicester NHS Trust; University of Leicester; Sandwell and West Birmingham NHS Trust
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Publication date
2022-07-25
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Abstract
Introduction: Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence.
Methods: One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables.
Results: The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01).
Conclusions: LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events.
Citation
Lane D, Beishon L, Sharma V, Salim F, Sze S, Timmins MA, Robinson T, Eveson D, Mistri A, Patel P, Gupta P. High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA. J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106665. doi: 10.1016/j.jstrokecerebrovasdis.2022.106665. Epub 2022 Jul 25. PMID: 35901588.
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Article