The quality of medication optimization among patients with transient ischemic attack or minor stroke

ObjectiveTo assess the quality of medication optimization for transient ischemic attack (TIA) and minor stroke patients across the Veterans Health Administration (VHA), and to identify characteristics predicting medication optimization for hypertension, hyperlipidemia, and diabetes. The scope of this study focuses on these three medication-related conditions and defines optimization as medication changes or additions made within a guideline-defined timeframe. MethodsWe constructed a retrospective cohort including all patients discharged with a TIA or minor stroke (index event) in any VHA Emergency Department (ED) or inpatient setting during fiscal year 2011. Inpatient and outpatient medical/pharmacy data were collected from a variety of electronic health sources for 1 year prior to and up to 90 days after discharge. Medication optimization for hypertension, hyperlipidemia, and diabetes was defined using relevant VHA and American Heart Association/American Stroke Association guidelines. For each of the three medication-based outcomes, multivariable logistic regression models examined demographic, past medical history, and other clinical variables to identify predictors of optimization. ResultsAmong 8427 patients, 33.7% (n = 2837) were eligible for medication optimization for hypertension, 55.2% (n = 4655) for hyperlipidemia, and 7.2% (n = 606) for diabetes. Guideline-concordant medication optimization occurred for 28% of eligible patients with hypertension, 28% of patients with hyperlipidemia, and 34% of patients with diabetes. Factors that were associated with medication optimization included younger age, inpatient stay (vs discharge from the ED), greater baseline disease severity (higher blood pressure, low-density lipoprotein [LDL] cholesterol, or hemoglobin A1c [glycated hemoglobin]), and primary care follow-up within 30 days after the index event. ConclusionOne-third or fewer eligible patients with TIA or minor stroke had their medications optimized in a timely manner in concordance with evidence-based guidelines. Interventions to improve timely medication optimization are needed to reduce the risk of recurrent vascular events in this high-risk population.