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Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis

BACKGROUND: Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention. OBJECTIVES: To investigate the effects of non-adherence to medications used to tr...

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Autores principales: Mafruhah, Okti Ratna, Huang, Yen-Ming, Lin, Hsiang-Wen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968645/
https://www.ncbi.nlm.nih.gov/pubmed/36843040
http://dx.doi.org/10.1007/s00415-023-11601-9
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author Mafruhah, Okti Ratna
Huang, Yen-Ming
Lin, Hsiang-Wen
author_facet Mafruhah, Okti Ratna
Huang, Yen-Ming
Lin, Hsiang-Wen
author_sort Mafruhah, Okti Ratna
collection PubMed
description BACKGROUND: Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention. OBJECTIVES: To investigate the effects of non-adherence to medications used to treat the modifiable risk of diseases on stroke-associated outcomes in primary stroke prevention. METHODS: Study records were searched from PubMed, Embase, and CINAHL. Those studies reported risks relevant to stroke-associated outcomes and medication non-adherence for patients diagnosed with four modifiable stroke-related diseases (atrial fibrillation [AF], hyperlipidemia, hypertension, and type 2 diabetes mellitus) but without stroke history were included for meta-analysis and further subgroup, sensitivity, and publication bias analyses. A random effect model was performed to analyse the pooled risk estimates of relative risk (RR) and 95% confidence intervals (CIs). RESULTS: Thirty-nine studies (with 2,117,789 participants in total) designed as cohort or case–control studies were included. Those patients presenting with four stroke-related diseases and categorised as medication non-adherent tended to result in stroke and/or associated death (all pooled RR ≥ 1 and 95% CI did not include 1). The findings of stratification and sensitivity analysis for each stroke-related disease showed a similar trend. Non-adherent patients with AF were prone to stroke occurrence (RR 1.852; 95% CI 1.583–2.166) but inclined to reduced bleeding (RR 0.894; 95% CI 0.803–0.996). The existence of publication bias warrants further interpretation. CONCLUSIONS: Non-adherence to medications for the four stroke-related diseases contributes to the development of stroke and/or mortality in primary stroke prevention. More efforts are needed to improve patients’ medication adherence. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-023-11601-9.
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spelling pubmed-99686452023-02-28 Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis Mafruhah, Okti Ratna Huang, Yen-Ming Lin, Hsiang-Wen J Neurol Review BACKGROUND: Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention. OBJECTIVES: To investigate the effects of non-adherence to medications used to treat the modifiable risk of diseases on stroke-associated outcomes in primary stroke prevention. METHODS: Study records were searched from PubMed, Embase, and CINAHL. Those studies reported risks relevant to stroke-associated outcomes and medication non-adherence for patients diagnosed with four modifiable stroke-related diseases (atrial fibrillation [AF], hyperlipidemia, hypertension, and type 2 diabetes mellitus) but without stroke history were included for meta-analysis and further subgroup, sensitivity, and publication bias analyses. A random effect model was performed to analyse the pooled risk estimates of relative risk (RR) and 95% confidence intervals (CIs). RESULTS: Thirty-nine studies (with 2,117,789 participants in total) designed as cohort or case–control studies were included. Those patients presenting with four stroke-related diseases and categorised as medication non-adherent tended to result in stroke and/or associated death (all pooled RR ≥ 1 and 95% CI did not include 1). The findings of stratification and sensitivity analysis for each stroke-related disease showed a similar trend. Non-adherent patients with AF were prone to stroke occurrence (RR 1.852; 95% CI 1.583–2.166) but inclined to reduced bleeding (RR 0.894; 95% CI 0.803–0.996). The existence of publication bias warrants further interpretation. CONCLUSIONS: Non-adherence to medications for the four stroke-related diseases contributes to the development of stroke and/or mortality in primary stroke prevention. More efforts are needed to improve patients’ medication adherence. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-023-11601-9. Springer Berlin Heidelberg 2023-02-27 2023 /pmc/articles/PMC9968645/ /pubmed/36843040 http://dx.doi.org/10.1007/s00415-023-11601-9 Text en © The Author(s) 2023, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Mafruhah, Okti Ratna
Huang, Yen-Ming
Lin, Hsiang-Wen
Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title_full Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title_fullStr Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title_full_unstemmed Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title_short Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
title_sort impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968645/
https://www.ncbi.nlm.nih.gov/pubmed/36843040
http://dx.doi.org/10.1007/s00415-023-11601-9
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