Figure 1
Flow chart of the study cohort.
IS = ischaemic stroke; TIA = transient ischaemic attack; HS = haemorrhagic stroke; MI = myocardial infarction; HF = heart failure; mRS = modified Rankin scale; NIHSS = National Institutes of Health Stroke Scale.
Table 1
Baseline characteristics of ABCstroke adherent and non-adherent patients.
| ALL PATIENTS (n = 9,669) | ABC ADHERENT (n = 5,618) | ABC NON-ADHERENT (n = 4,051) | p VALUE | |
|---|---|---|---|---|
| Age (years) | 69.6 ± 13.4 | 67.9 ± 12.7 | 72.0 ± 14.0 | <0.001 |
| Male | 5,560 (57.5) | 3,336 (59.4) | 2,224 (54.9) | <0.001 |
| Smoking | 3,276 (33.9) | 2,026 (36.1) | 1,250 (30.9) | <0.001 |
| Alcohol | 1,908 (19.7) | 1,186 (21.1) | 722 (17.8) | <0.001 |
| NIHSS | 3 [1–6] | 3 [1–5] | 4 [1–9] | <0.001 |
| Baseline comorbidities | ||||
| Atrial fibrillation | 222 (2.3) | 85 (1.5) | 137 (3.4) | <0.001 |
| Hypertension | 812 (8.4) | 442 (7.9) | 370 (9.1) | 0.029 |
| Ischaemic heart disease | 154 (1.6) | 73 (1.3) | 81 (2.0) | 0.009 |
| Diabetes mellitus | 498 (5.2) | 254 (4.5) | 244 (6.0) | 0.001 |
| Dyslipidaemia | 249 (2.6) | 155 (2.8) | 94 (2.3) | 0.201 |
| Chronic kidney disease | 98 (1.0) | 42 (0.7) | 56 (1.4) | 0.003 |
| Chronic liver disease | 49 (0.5) | 20 (0.4) | 29 (0.7) | 0.021 |
| Dementia | 196 (2.0) | 52 (0.9) | 144 (3.6) | <0.001 |
| Baseline medication use | ||||
| ACEi | 1,543 (16.0) | 859 (15.3) | 684 (16.9) | 0.037 |
| ARB | 536 (5.5) | 329 (5.9) | 207 (5.1) | 0.124 |
| Beta-blocker | 2,018 (20.9) | 1,052 (18.7) | 966 (23.8) | <0.001 |
| CCB | 3,016 (31.2) | 1,684 (30.0) | 1,332 (32.9) | 0.003 |
| Aspirin | 1,567 (16.2) | 773 (13.8) | 794 (19.6) | <0.001 |
| P2Y12 inhibitor | 90 (0.9) | 43 (0.8) | 47 (1.2) | 0.059 |
| Warfarin | 108 (1.1) | 34 (0.6) | 74 (1.8) | <0.001 |
| NOAC | 70 (0.7) | 25 (0.4) | 45 (1.1) | <0.001 |
| Insulin | 325 (3.4) | 191 (3.4) | 134 (3.3) | 0.849 |
| Metformin | 1,370 (14.2) | 833 (14.8) | 537 (13.3) | 0.031 |
| Statin | 1,849 (19.1) | 1,204 (21.4) | 645 (15.9) | <0.001 |
[i] Values are shown as mean ± standard deviation, median [interquartile range], or n (%).
NIHSS = National Institutes of Health Stroke Scale; ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; CCB = calcium channel blocker; NOAC = non-vitamin K antagonist oral anticoagulants.
Figure 2
Distribution of ABCstroke criteria adherence and the number of ABCstroke criteria attained.
Table 2
Effect of ABCstroke pathway adherence on the risk for adverse cardiovascular events and death.
| EVENT NUMBER (%) | UNADJUSTED HR/SHR (95% CI) | p VALUE | ADJUSTED HR/SHR (95% CI) | p VALUE | |
|---|---|---|---|---|---|
| Composite outcome | |||||
| ABC adherent | 783 (13.9) | 0.59 (0.54–0.65) | <0.001 | 0.80 (0.72–0.88) | <0.001 |
| ABC non-adherent | 899 (22.2) | Ref. | Ref. | ||
| Recurrent IS* | |||||
| ABC adherent | 331 (5.9) | 0.95 (0.81–1.12) | 0.570 | 1.00 (0.84–1.19) | 0.990 |
| ABC non-adherent | 250 (6.2) | Ref. | Ref. | ||
| TIA* | |||||
| ABC adherent | 71 (1.3) | 1.35 (0.91–2.00) | 0.140 | 1.29 (0.86–1.95) | 0.220 |
| ABC non-adherent | 38 (0.9) | Ref. | Ref. | ||
| HS* | |||||
| ABC adherent | 83 (1.5) | 0.38 (0.29–0.49) | <0.001 | 0.50 (0.38–0.67) | <0.001 |
| ABC non-adherent | 157 (3.9) | Ref. | Ref. | ||
| MI* | |||||
| ABC adherent | 70 (1.2) | 0.90 (0.63–1.28) | 0.560 | 1.16 (0.79–1.70) | 0.440 |
| ABC non-adherent | 56 (1.4) | Ref. | Ref. | ||
| HF* | |||||
| ABC adherent | 124 (2.2) | 0.54 (0.43–0.68) | <0.001 | 0.77 (0.60–1.00) | 0.048 |
| ABC non-adherent | 165 (4.1) | Ref. | Ref. | ||
| Cardiovascular death* | |||||
| ABC adherent | 60 (1.1) | 0.44 (0.32–0.61) | <0.001 | 0.64 (0.45–0.90) | 0.011 |
| ABC non-adherent | 97 (2.4) | Ref. | Ref. | ||
| All-cause mortality | |||||
| ABC adherent | 280 (5.0) | 0.43 (0.37–0.50) | <0.001 | 0.72 (0.62–0.85) | <0.001 |
| ABC non-adherent | 455 (11.2) | Ref. | Ref. |
[i] IS = ischaemic stroke; TIA = transient ischaemic attack; HS = haemorrhagic stroke; MI = myocardial infarction; HF = heart failure; HR = hazard ratio; SHR = subdistribution hazard ratio; CI = confidence interval.
* = Fine-Gray model was used to adjust for competing risk, with death being the competing event.
Figure 3
Kaplan-Meier curve showing (A) the risk of composite outcome between ABCstroke adherent and ABCstroke non-adherent patients; and (B) the risk of composite outcome in patients with 0 or 1 ABCstroke criteria compared with patients with 2 or 3 ABCstroke criteria attained.
Table 3
Effect of adherence to each component of the ABCstroke pathway on the risk for adverse cardiovascular events and death.
| CRITERION | ADJUSTED HR/SHR (95% CI) | |
|---|---|---|
| Composite outcome | A | 0.60 (0.53–0.68) |
| B | 0.97 (0.85–1.10) | |
| C | 0.85 (0.77–0.95) | |
| Recurrent IS* | A | 0.99 (0.77–1.28) |
| B | 1.13 (0.87–1.47) | |
| C | 1.00 (0.83–1.20) | |
| TIA* | A | 1.62 (0.74–3.54) |
| B | 1.18 (0.61–2.27) | |
| C | 1.10 (0.70–1.71) | |
| HS* | A | 0.20 (0.15–0.26) |
| B | 1.38 (0.93–2.03) | |
| C | 0.62 (0.48–0.81) | |
| MI* | A | 0.97 (0.56–1.67) |
| B | 0.96 (0.59–1.57) | |
| C | 1.09 (0.73–1.64) | |
| HF* | A | 0.65 (0.48–0.88) |
| B | 0.91 (0.67–1.26) | |
| C | 0.82 (0.63–1.06) | |
| Cardiovascular death* | A | 0.55 (0.37–0.81) |
| B | 0.95 (0.63–1.42) | |
| C | 0.60 (0.43–0.85) | |
| All-cause mortality | A | 0.69 (0.58–0.83) |
| B | 0.80 (0.67–0.95) | |
| C | 0.84 (0.72–0.98) |
[i] IS = ischaemic stroke; TIA = transient ischaemic attack; HS = haemorrhagic stroke; MI = myocardial infarction; HF = heart failure; HR = hazard ratio; SHR = subdistribution hazard ratio; CI = confidence interval.
* = Fine-Gray model was used to adjust for competing risk, with death being the competing event.
Figure 4
Subgroup analysis for the risk of composite outcome in different subgroups.
HTN = hypertension; DM = diabetes mellitus; NIHSS = National Institutes of Health Stroke Scale; HR = hazard ratio; CI = confidence interval.