POST-STROKE FATIGUE AND PHARMACOTHERAPY DURING HOSPITAL STAY IN PATIENTS WITH ACUTE CEREBROVASCULAR EVENTS
About the author:
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Post-stroke fatigue (PSF) is quite specific post-stroke complication that is present in 28.1-54.7% patients within the first year after acute cerebrovascular event (ACE) occurrence depending on observation time points. Up to now, there is insufficient understanding the mechanisms that underlie PSF occurrence and PSF further persistence for different post-stroke periods of time and as consequence there is lack of PSF effective management. On the other hand, fatigue may be as a side effect of many drugs. Therefore, at present, there is a need for a prospective study about associations between pharmacotherapy peculiarities and regularities of PSF onset and its subsequent clinical course. Objective. To investigate potential relationships between pharmacotherapy peculiarities during hospital stay due to ACE and regularities of PSF onset and PSF time course within the first post-stroke year. Object and methods. The study included 386 patients with ACE (268 had ischemic strokes, 51 – hemorrhagic strokes and 67 transient ischemic attacks). Exclusion criteria were major medical illness that could cause secondary fatigue (oncological, hematological diseases, cardiac, liver, kidney and respiratory insufficiency, progressive angina pectoris, acute myocardial infarction), alcohol abuse, consciousness impairments, insufficient cognitive ability (Mini-Mental State Examination scores less than 24), depressive and anxious disorders (Hospital Anxiety and Depression Scale scores more than 10 for both pathologies), impaired speech function to participate (severe dysphasia or dysarthria), impaired language or written ability to complete the study questionnaires, severe functional disabilities (modified Rankin scale scores ≥4). Patients’ characteristics were evaluated in definite time points: at hospital stay, at 1, 3, 6, 9 and 12 months after ACE occurrence. PSF and its components were measured by three self-report questionnaires: fatigue assessment scale (FAS), fatigue severity scale (FSS) and multidimensional fatigue inventory-20 (MFI-20). PSF characteristics included time of occurrence, time of disappearance, duration, intensity. Characteristics of hospital pharmacotherapy (groups of used drugs, number of drugs prescribed for patient) were analyzed using a special algorithm. Results and discussion. There were no associations between any drugs group as well as between number of used drugs and PSF characteristics (rates and intensities) within the whole one year observation period. There was tendency for increasing of global PSF rate during hospital stay period in patients who used anxiolytics (р=0,08). There were no associations between number of used drugs at hospital stay and occurrence of new PSF cases in any time point within observation period. On the other hand it had been revealed direct significant correlations between number of prescribed drugs during hospital treatment and risk of PSF persistence during the first post-stroke year – according to FAS (Kendall’s tau coefficient 0,32, p=0,002), according FSS (Kendall’s tau coefficient 0,23, p=0,02), according to MFI-20 global and physical fatigue sub-scales (Kendall’s tau coefficients 0,29, p=0,01 and 0,28, p=0,01, respectively). From clinical point of view, perhaps, reducing the number of prescribed drugs during hospital treatment in patients who had already PSF may decrease the risk of PSF persistence, at least for the first post-stroke year. Conclusions. 1. Quantitative and qualitative characteristics of hospital pharmacotherapy due to ACE do not have any reliable associations with PSF rates and PSF intensities within the first post-stroke year. 2. Polypharmacy during hospital treatment for ACE may be one of the factors contributing to PSF persistence over the next one-year period.
stroke, fatigue, prevalence, intensity, polypharmacy
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 101-105 pages, index UDK 616.831-005.1-085