Acompanhamento farmacoterapêutico de pacientes pós-AVC: um estudo de coorte

Abstract

Introduction: Individuals affected by a Stroke (Cerebrovascular Accident - CVA) tend to engage in polypharmacy, which is the use of 5 or more medications, bringing various concerns related to pharmacotherapy. Performing pharmacotherapeutic follow-up and identifying medication-related problems and correlating them with risk factors for stroke is essential to prevent its recurrence. Objective: To evaluate medication-related problems (MRPs) such as adherence to pharmacotherapy, drug interactions, and adverse reactions to prescribed medications from hospital discharge up to the sixth month after the stroke. Methods: This is an observational, longitudinal cohort study that included individuals with a clinical diagnosis of ischemic or hemorrhagic stroke from the 1st to the 30th day after hospital discharge. Initially (T1), the individuals signed the Informed Consent Form (ICF) and filled out an evaluation form containing information about name, gender, date of birth, education level, type of stroke, and average monthly income. After this, the individuals were contacted every 15 days and evaluated remotely through calls and/or text messages every 30 days, for a total of 6 months (T1 to T6). During follow-ups, participants were assessed using the following instruments: 1. Naranjo Algorithm: observation of possible adverse drug reactions; 2. Micromedex: evaluates drug interactions by observing MRPs and negative medication outcomes (NMOs); 3. Adapted Morisky-Green Questionnaire for assessing adherence to pharmacotherapy. Regarding stroke severity and functional capacity, participants were evaluated using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale, respectively. To measure risk factors associated with a possible secondary stroke, participants were classified using the Stroke Riskometer. Data were analyzed using JASP STATISTICS software; the Shapiro-Wilk test was used to analyze data distribution and the Spearman test to evaluate the correlation between clinical instruments and NMOs and MRPs. Results: During the entire follow-up period, it was observed that 9 participants had some level of functional impairment. The median score on the Rankin scale was (3.72) (range: 4.0-4.5); additionally, the 11 participants had a median (10.18) on the NIHSS. Adverse drug reactions (ADRs) were reported, with muscle weakness being the most cited, occurring in (63.6%) of individuals in the first month and remaining at (55.5%) in the following months. Moderate and severe drug interactions occurred in (72.7%) of the participants, and insecurity (non-quantitative insecurity) was present in (81.8%) of the cases studied. These situations result in negative health outcomes for individuals. Three participants (27.2%) scored negatively on all adherence questions in the adapted Morisky-Green questionnaire, resulting in low or no adherence to the prescribed pharmacotherapy. No participant was followed by a pharmaceutical care program during this study. Conclusion: This study demonstrated that post-stroke patients have various pharmacotherapy-related problems, with adverse reactions, drug interactions, and non-adherence to pharmacotherapy being the main MRPs that generate NMOs and consequently negative health outcomes. Furthermore, we observed that the follow-up by pharmaceutical professionals for these patients is still deficient. It suggests that the inclusion of pharmaceutical professionals in the follow-up of these patients tends to minimize risk factors, preventing a secondary stroke.