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Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors.

Publication ,  Journal Article
Etherton, MR; Shah, S; Haolin, X; Xian, Y; Maisch, L; Hannah, D; Lindholm, B; Lytle, B; Thomas, L; Smith, EE; Fonarow, GC; Schwamm, LH ...
Published in: Stroke Vasc Neurol
September 2021

BACKGROUND AND PURPOSE: Depression is common after stroke and is often treated with antidepressant medications (AD). ADs have also been hypothesised to improve stroke recovery, although recent randomised trials were neutral. We investigated the patterns of in-hospital AD initiation after ischaemic stroke and association with clinical and readmission outcomes. METHODS: All Medicare fee-for-service beneficiaries aged 65 or older hospitalised for ischaemic stroke in participating Get With The Guidelines-Stroke hospitals between April and December 2014 were eligible for this analysis. Outcome measures included days alive and not in a healthcare institution (home time), all-cause mortality and readmission within 1-year postdischarge. Propensity score (PS)-adjusted logistic regression models were used to evaluate the associations between AD use and each outcome measure. We also compared outcomes in patients prescribed selective serotonin reuptake inhibitors (SSRIs) AD versus those prescribed non-SSRI ADs. RESULTS: Of 21 805 AD naïve patients included in this analysis, 1835 (8.4%) were started on an AD at discharge. Patients started on an AD had higher rates of depression and prior ischaemic stroke, presented with higher admission National Institutes of Health Stroke Scale score and were less likely to be discharged home. Similarly, patients started on an SSRI had lower rates of discharge to home. Adjusting for stroke severity, patients started on an AD had worse all-cause mortality, all-cause readmission, major adverse cardiac events, readmission for depression and decreased home-time. However, AD use was also associated with an increased risk for the sepsis, a falsification endpoint, suggesting the presence of residual confounding. CONCLUSIONS: Patients with ischaemic stroke initiated on AD therapy are at increased risk of poor clinical outcomes and readmission even after PS adjustment, suggesting that poststroke depression requiring medication is a poor prognostic sign. Further research is needed to explore the reasons why depression is associated with worse outcome, and whether AD treatment modifies this risk or not.

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Published In

Stroke Vasc Neurol

DOI

EISSN

2059-8696

Publication Date

September 2021

Volume

6

Issue

3

Start / End Page

384 / 394

Location

England

Related Subject Headings

  • United States
  • Survivors
  • Stroke
  • Patient Discharge
  • Medicare
  • Ischemic Stroke
  • Humans
  • Brain Ischemia
  • Antidepressive Agents
  • Aged
 

Citation

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Etherton, M. R., Shah, S., Haolin, X., Xian, Y., Maisch, L., Hannah, D., … O’Brien, E. C. (2021). Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke Vasc Neurol, 6(3), 384–394. https://doi.org/10.1136/svn-2020-000691
Etherton, Mark R., Shreyansh Shah, Xu Haolin, Ying Xian, Lesley Maisch, Deidre Hannah, Brianna Lindholm, et al. “Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors.Stroke Vasc Neurol 6, no. 3 (September 2021): 384–94. https://doi.org/10.1136/svn-2020-000691.
Etherton MR, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, et al. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke Vasc Neurol. 2021 Sep;6(3):384–94.
Etherton, Mark R., et al. “Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors.Stroke Vasc Neurol, vol. 6, no. 3, Sept. 2021, pp. 384–94. Pubmed, doi:10.1136/svn-2020-000691.
Etherton MR, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith EE, Fonarow GC, Schwamm LH, Bhatt DL, Hernandez AF, O’Brien EC. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke Vasc Neurol. 2021 Sep;6(3):384–394.

Published In

Stroke Vasc Neurol

DOI

EISSN

2059-8696

Publication Date

September 2021

Volume

6

Issue

3

Start / End Page

384 / 394

Location

England

Related Subject Headings

  • United States
  • Survivors
  • Stroke
  • Patient Discharge
  • Medicare
  • Ischemic Stroke
  • Humans
  • Brain Ischemia
  • Antidepressive Agents
  • Aged