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Background: Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke. Methods: A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012–2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights. Results: Among 4076 eligible participants (median age 68 years; 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54–0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62–0.98) than those with a proportion of days covered Conclusions: High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.

Introduction: Observational studies are increasingly being used to provide evidence on the real-world effectiveness of medications for preventing vascular diseases, such as stroke. We investigated whether the real-world effectiveness of treatment with lipid-lowering medications after ischemic stroke is affected by prevalent-user bias. Methods: An observational cohort study of 90-day survivors of ischemic stroke using person-level data from the Australian Stroke Clinical Registry (2012–2016; 45 hospitals) linked to administrative (pharmaceutical, hospital, death) records. The use of, and adherence to (proportion of days covered Results: Of 11,217 eligible patients (median age 72 years, 42% female), 9,294 (83%) used lipid-lowering medications within 90 days post-discharge, including 5,479 new users. In both prevalent-user and new-user designs, nonusers (vs. users) had significantly greater rates of mortality (hazard ratio [HR] 2.35, 95% CI: 1.89–2.92) or all-cause readmissions (HR 1.22, 95% CI: 1.05–1.40) but not cardiovascular disease readmission. In contrast, associations between having poor (vs. good) adherence on outcomes were stronger among new users than all users. Among new users, having poor adherence was associated with greater rates of mortality (HR 1.48, 95% CI: 1.12–1.96), all-cause readmission (HR 1.14, 95% CI: 1.02–1.27), and cardiovascular disease readmission (HR 1.20, 95% CI: 1.01–1.42). Conclusions: The real-world effectiveness of treatment with lipid-lowering medications after stroke is attenuated when evaluated based on prevalent-user rather than new-user design. These findings may have implications for designing studies on the real-world effectiveness of secondary prevention medications.

Background and Purpose: Primary care physicians (PCPs) provide ongoing management after stroke. However, little is known about how best to measure physician encounters with reference to longer term outcomes. We aimed to compare methods for measuring regularity and continuity of PCP encounters, based on survival following stroke using linked healthcare data. Methods: Data from the Australian Stroke Clinical Registry (2010–2014) were linked with Australian Medicare claims from 2009 to 2016. Physician encounters were ascertained within 18 months of discharge for stroke. We calculated three separate measures of continuity of encounters (consistency of visits with primary physician) and three for regularity of encounters (distribution of service utilization over time). Indices were compared based on 1-year survival using multivariable Cox regression models. The best performing measures of regularity and continuity, based on model fit, were combined into a composite “optimal care” variable. Results: Among 10,728 registrants (43% female, 69% aged ≥65 years), the median number of encounters was 17. The measures most associated with survival (hazard ratio [95% confidence interval], Akaike information criterion [AIC], and Bayesian information criterion [BIC]) were the Continuity of Care Index (COCI, as a measure of continuity; 0.88 [0.76–1.02], p = 0.099, AIC = 13,746, BIC = 13,855) and our persistence measure of regularity (encounter at least every 6 months; 0.80 [0.67–0.95], p = 0.011, AIC = 13,742, BIC = 13,852). Our composite measure, persistent plus COCI ≥80% (24% of registrants; 0.80 [0.68–0.94], p = 0.008, AIC = 13,742, BIC = 13,851), performed marginally better than our persistence measure alone. Conclusions: Our persistence measure of regularity or composite measure may be useful when measuring physician encounters following stroke.

Oral and Poster Abstracts (in alphabetical order of first author) The following abstracts were accepted for presentation at the Stroke Society of Australasia Annual Scientific Meeting of 2021. We thank the authors for their contribution to the meeting and the Scientific Committee for their valuable input into the program. Erin Godecke and Nawaf Yassi Scientific Committee Co-Chairs

Background: Evidence is growing on anticancer effects of statins. We investigated whether the effectiveness of treatment with statins after ischemic stroke on mortality is influenced by a history of cancer. Methods: Analyses of 90-day survivors of ischemic stroke (2012–2016; 45 hospitals) using linked registry and administrative data. Dispense of statins within 90 days postdischarge was determined from pharmaceutical records. Participants were followed from 91 days postdischarge until death or June 30, 2018. History of cancer was determined from hospital data. Propensity score–adjusted Cox proportional hazards regression model was used to determine the association between being dispensed statins and survival. The influence of history of cancer on this association was assessed based on the concepts of (1) statistical interaction and (2) biological interaction using 3 indices: relative excess risk due to interaction>0, attributable proportion due to interaction >0, or synergy index >1. Results: Among 9948 eligible participants (median age=72 years, 42% female), there were 1463 deaths. In adjusted analyses, there was no statistical interaction between being dispensed statins and history of cancer on mortality ( P =0.156). However, being dispensed statins had a significant positive biological interaction with having a history of cancer on mortality: relative excess risk due to interaction, 2.80 (95% CI, 1.56–5.05), attributable proportion due to interaction, 0.45 (95% CI, 0.23–0.66), and synergy index, 2.14 (95% CI, 1.32–3.49). Conclusions: Treatment with statins after ischemic stroke may confer additional survival benefits for people who also have had cancer.

To describe types of mental health treatment accessed by community-based stroke survivors and factors associated with access. A sub-group of registrants from the Australian Stroke Clinical Registry completed a supplementary survey 2.5 years post-stroke. Self-reported information about depression/anxiety and treatment access were collected. Demographic and clinical data were obtained through linkages with registry and government data. Staged multivariable logistic regression was conducted to examine factors associated with treatment access. Among 623 registrants surveyed (37% female, median age 69 years), 26% self-reported a medical diagnosis of depression/anxiety at 2.5 years post-stroke. Of these, only 30% reported having accessed mental health services, mostly through government-funded Medicare schemes. Younger age (odds ratio (OR) 0.95, 95% CI 0.93, 0.98), history of mental health treatment (OR 3.38, 95% CI 1.35, 8.48), feeling socially isolated (OR 2.32, 95% CI 1.16, 4.66), self-reported medical diagnosis of depression/anxiety (OR 4.85, 95% CI 2.32, 10.14), and government-subsidised team care plan arrangement (OR 4.05, 95% CI 1.96, 8.37) were associated with receiving treatment. Many stroke survivors have untreated depression/anxiety. Primary care practitioners should be supported in undertaking effective detection and management. Older and newly diagnosed individuals should be educated about depression/anxiety and available supports.Implications for rehabilitationPrimary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary.Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke.Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients��� multiple and complex rehabilitation needs.Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services. Primary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary. Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke. Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients��� multiple and complex rehabilitation needs. Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services.

Health-related quality of life (QoL) is poor after stroke, but may be improved with comprehensive care plans. We aimed to determine the effects of an individualized management program on QoL in people with stroke or transient ischemic attack (TIA), describe changes in QoL over time, and identify variables associated with QoL.This was a multicenter, cluster randomized controlled trial with blinded assessment of outcomes and intention-to-treat analysis. Patients with stroke or TIA aged ≥ 18 years were randomized by general practice to receive usual care or an intervention comprising a tailored chronic disease management plan and education. QoL was assessed at baseline and 3, 12, and 24 months after baseline using the Assessment of Quality of Life instrument. Patient responses were converted to utility scores ranging from - 0.04 (worse than death) to 1.00 (good health). Mixed-effects models were used for analyses.Among 563 participants recruited (mean age 68.4 years, 64.5% male), median utility scores ranged from 0.700 to 0.772 at different time points, with no difference observed between intervention and usual care groups. QoL improved significantly from baseline to 3 months (ß = 0.019; P = 0.015) and 12 months (ß = 0.033; P 0.001), but not from baseline to 24 months (ß = 0.013; P = 0.140) in both groups combined. Older age, females, lower educational attainment, greater handicap, anxiety and depression were longitudinally associated with poor QoL.An individualized management program did not improve QoL over 24 months. Those who are older, female, with lower educational attainment, greater anxiety, depression and handicap may require greater support.https://www.anzctr.org.au . Unique identifier: ACTRN12608000166370.

The activity of colloidally synthesized CoP for the hydrogen evolution reaction (HER) was studied to determine the impact of surface ligands on catalysis. The as-synthesized CoP nanocrystals were s...

We have broadened the scope of the aminophosphine precursor chemistry that has been developed for InP quantum dots to the synthesis of cadmium, zinc, cobalt, and nickel phosphide nanocrystals. The ...

PURPOSE Prescribed daily dose (PDD), the number of doses prescribed to be taken per day, is used to calculate medication adherence using pharmacy claims data. PDD can be substituted by (i) one dose per day (1DD), (ii) an estimate based on the 75th percentile of days taken by patients to refill a script (PDD75 ) or (iii) the World Health Organization's defined daily dose (DDD). We aimed to compare these approaches for estimating the duration covered by medications and whether this affects calculated 1-year adherence to antihypertensive medications post-stroke. METHODS We conducted a retrospective review of prospective cohort data from the ongoing Australian Stroke Clinical Registry linked with pharmacy claims data. Adherence was calculated as the proportion of days covered (PDC) for 1DD, PDD75 and DDD. Differences were assessed using Wilcoxon rank-sum tests. RESULTS Among 12 628 eligible patients with stroke, 10 057 (80%) were prescribed antihypertensive medications in the year after hospital discharge (78.2% aged ≥65 years, 45.2% female). Overall, the 75th percentile of patient time until next medication refill was 39 days. The greatest variations in dose regimens, estimated using person- and dose-level refill times, were for beta blockers (11.4% taking two tablets/day). There were comparable levels of adherence between 1DD and the PDD75 (median PDC 91.0% vs 91.2%; P = 0.70), but adherence was slightly higher using DDD (92.3%; both P < 0.001). However, this would represent a clinically nonsignificant difference. CONCLUSION Adherence to antihypertensive medications shows similar estimates across standard measures of dosage in patients during the first year after an acute stroke.

Cobalt phosphide (CoP) is one of the most promising earth-abundant replacements for noble metal catalysts for the hydrogen evolution reaction (HER). Critical to HER is the binding of H atoms. While theoretical studies have computed preferred sites and energetics of hydrogen bound to transition metal phosphide surfaces, direct experimental studies are scarce. Herein, we describe measurements of stoichiometry and thermochemistry for hydrogen bound to CoP. We studied both mesoscale CoP particles, exhibiting phosphide surfaces after an acidic pretreatment, and colloidal CoP nanoparticles. Treatment with H2 introduced large amounts of reactive hydrogen to CoP, ca. 0.2 H per CoP unit, and on the order of one H per Co or P surface atom. This was quantified using alkyne hydrogenation and H-atom transfer reactions with phenoxy radicals. Reactive H atoms were even present on the as-prepared materials. On the basis of the reactivity of CoP with various molecular hydrogen donating and accepting reagents, the distribution of binding free energies for H atoms on CoP was estimated to be roughly 51-66 kcal mol-1 (ΔG°H ≅ 0 to -0.7 eV vs H2). Operando X-ray absorption spectroscopy gave preliminary indications about the structure of hydrogenated CoP, showing a slight lattice expansion and no significant change of the effective nuclear charge of Co under H2-flow. These results provide a new picture of catalytically active CoP, with a substantial amount of reactive H atoms. This is likely of fundamental relevance for its catalytic and electrocatalytic properties. Additionally, the approach developed here provides a roadmap to examine hydrogen on other materials.

We are interested in achieving control of heterogeneous interfaces to promote inner-sphere electron-proton-transfer reactions using insights from molecular chemistry. Toward this end, we are developing solution-phase methods for the synthesis and post-synthetic modification of colloidal nanostructures with low overpotentials and high activity for multi-electron, multi-proton electrocatalytic reactions. Ligand exchange, surface etching, and covalent modification will be presented as complementary methods for altering the catalytic activity of colloidal transition metal phosphide electrocatalysts. A combination of electrochemical characterization, structural analysis, and electronic structure characterization will be presented. Together with stoichiometric probes of inner-sphere reactivity, these data will serve to reveal mechanistic details and design principles for catalysis in these systems.

Background: Chronic Disease Management (CDM) plans are usually administered by general practitioners (GPs) to assist those with a chronic medical condition, such as stroke, and provide better management of risk factors. Despite the prevalent use of CDM plans, its comprehensiveness and the fact that there is a government commitment to fund it, there is limited evidence of its effectiveness in Australian survivors of stroke. We aimed to assess the effectiveness of CDM plans on preventing the recurrence of CVD-related serious adverse events. Methods: Patients comprised survivors of stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563). We used standardised anthropometric, biochemical and blood pressure data, collected at baseline, to evaluate risk factors for stroke/TIA. Poisson regression models were used to determine the incidence rate ratio (IRRs) of increasing exposure to being on a CDM plan over 3 years, while adjusting for confounding factors. We used the total count of CVD-related events and deaths within 3 years after stroke/TIA, based on either hospital discharge codes or adjudication by two independent stroke specialists. Results: Five hundred and sixty-three patients were included (median age 70; 36% female). There were 305 CVD-related events over the three years (mean 0.54), in which a third (104) were adjudicated and two-thirds (201) were derived from hospital discharge codes alone. Nearly a quarter (27%) did not take up a CDM plan over the three years, a third (33%) were on plans for less than 1.5 years and 40% were on plans from 1.5 years to 3 years. The factors most strongly associated with decreased incidence of CVD-related events were duration on a CDM plan (Adjusted IRR (aIRR) 0.85, 95% confidence interval (95%CI) 0.77-0.93; p Conclusion: Being on a CDM plan for a longer duration appeared to reduce the occurrence of CVD-related events within 3 years after stroke, potentially via more closely controlled risk factors. Patients should be encouraged to return for regular reviews of their CDM plans to enhance secondary prevention strategies, and maintain a better quality of life.

Background: Prognostic performances of models predicting risk of recurrent events of cardiovascular disease (CVD) are not adequate for use in clinical settings. We aimed to determine whether adapting the Framingham Risk Score (FRS) to an Australian population could effectively predict recurrent cardiovascular outcomes. Methods: Patients comprised survivors of stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563). We used standardised anthropometric, biochemical and blood pressure data, collected at baseline, to evaluate risk factors for stroke/TIA. Cox proportional hazards regression models were used to determine the risk of recurrence of CVD-related events and deaths within 3 years after stroke/TIA; adjudicated by two independent stroke specialists. Regression estimates were then used to recalibrate the coefficients used by the FRS, and performance of the model assessed. Results: In women, the recalibrated FRS model had poor discrimination (C-statistic = 0.634) and appeared to better predict CVD recurrence (AUC = 0.664) than the original FRS model (AUC = 0.598). However in men, the recalibrated FRS model had poor discrimination (C-statistic = 0.604) and prediction of CVD recurrence (AUC = 0.632) similar to the original FRS model (AUC = 0.606). Conclusion: The original FRS and recalibrated FRS models appeared to perform poorly in Australian men and women with stroke. The identification of relevant risk factors, easily measured in a clinical setting, may help clinicians better monitor the risks of their patients and enhance secondary prevention strategies.

Background: Hospital, emergency presentation and death databases are frequently used to research outcomes after stroke. The reliability of diagnostic coding for cardiovascular disease (CVD) in these administrative data remains uncertain. We aimed to determine the reliability of these data in Australia using an existing clinical trial cohort. Methods: Patients with stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563, recruited from 4 hospitals within Victoria). We used diagnostic ICD-10-AM coded data from hospital, emergency department and death databases within 2 years after stroke/TIA. Medical records for these potential CVD-related events were reviewed by two independent stroke specialists and adjudicated according to strict criteria. We then estimated sensitivity and specificity of using either primary or both primary and secondary diagnoses fields (obtained for all adjudicated records), against the events adjudicated by the specialists (gold standard). False positives were CVD-events defined by ICD-10-AM diagnostic codes that were adjudicated as not being a CVD-event. False negatives were true CVD-events that were misclassified as not being CVD-related when using ICD-10-AM codes. Results: We identified 261 events for medical review. After adjudication, 65 were classified as CVD-events (cases) and 196 were not CVD-events. Using both primary and secondary diagnoses, 55 true positives were correctly identified among the cases (sensitivity = 84.6%) and 129 true negatives among the non-cases (specificity = 65.8%). Using only primary diagnoses, 48 true positives were identified (sensitivity = 73.9%) and 171 true negatives (specificity = 87.2%). Using both primary and secondary diagnoses had an increased sensitivity, but decreased specificity (area under the Receiver Operating Characteristic curve (AUC) = 0.75; 95% CI, 0.70, 0.81) when compared with using only primary diagnoses (AUC = 0.81; 95% CI, 0.75, 0.86; p = 0.028). Conclusion: Both primary and secondary diagnoses should be used to identify true CVD-events and minimise misclassifying these in administrative databases.

Introduction: Severity of stroke impacts functional outcomes after stroke, but the role of this disability on secondary prevention is unclear. We investigated the effect of disability status on secondary prevention outcomes, such as the management of risk factors, knowledge regarding secondary prevention, and long-term unmet needs. Methods: Post-hoc analysis of a clinical trial of community-dwelling adults with stroke/TIA in Melbourne, Australia. Demographic/clinical data were obtained from hospital records, while standardised assessments were conducted for disability, cardiovascular risk, and mood. Disability was defined using the modified Rankin Scale (mRS): no disability (mRS=0), no significant disability (mRS=1), or slight to severe disability (mRS 2-5). Two-year outcomes included the standardized cardiovascular Framingham risk score, unmet needs, and knowledge of risk factors and medications prescribed for secondary prevention. Multivariable regression models were used to determine the effect of disability status on outcomes. Results: From January 2010 to November 2013, 563 survivors of stroke/TIA were recruited: median age 70.1 years, 65% males, 79% ischemic stroke, and 29% with no disability. After a 2-year follow-up, 86% provided outcome data. In the multivariable regression analyses, when compared to participants with no significant disability, those with slight/severe disability had greater cardiovascular risk scores (odds ratio 1.33, 95% CI 1.00-1.76). A dose-response effect was found for disability status and long-term unmet needs, with more unmet needs reported among those with no significant disability (incidence risk ratio 1.55, 95% CI 1.21-1.99) or with slight/severe disability (incidence risk ratio 1.64, 95% CI 1.24-2.16), than in those with no disability. We found no effect of disability status on knowledge of risk factors or medications. Conclusions: After a 24-month follow-up, survivors of stroke/TIA with disability had worse risk profiles and more unmet needs than those with no disability, and may benefit from targeted care post-discharge.

A series of four new bis-P2N2 (P2N2 = 1,5-diaza-3,7-diphosphacyclooctane) Pd(II) complexes were synthesized and characterized by spectroscopy, electrochemistry, and X-ray crystallography. The compounds crystallize in square planar or tetrahedrally distorted geometries and exhibit a single quasi-reversible 2e– Pd(II/0) redox couple in voltammetric studies. [Pd(PPh2NBn2)2]2+ and [Pd(PMe2NPh2)2]2+ were tested for electrochemical CO2 reduction in the presence of excess protons and found to preferentially produce H2.

Background and Purpose— Despite the benefit of risk awareness in secondary prevention, survivors of stroke are often unaware of their risk factors. We determined whether a nurse-led intervention improved knowledge of risk factors in people with stroke or transient ischemic attack. Methods— Prospective study nested within a randomized controlled trial of risk factor management in survivors of stroke or transient ischemic attack. Intervention: 3 nurse education visits and specialist review of care plans. Outcome: unprompted knowledge of risk factors of stroke or transient ischemic attack at 24 months. Effect of intervention on knowledge and factors associated with knowledge were determined using multivariable regression models. Results— Knowledge was assessed in 268 consecutive participants from the main trial, 128 in usual care and 140 in the intervention. Overall, 34% of participants were unable to name any risk factor. In adjusted analyses, the intervention group had better overall knowledge than controls (incidence risk ratio, 1.26; 95% confidence interval, 1.00–1.58). Greater functional ability and polypharmacy were associated with better knowledge and older age and having more comorbidities associated with poorer knowledge. Conclusions— Overall knowledge of risk factors of stroke or transient ischemic attack was better in the intervention group than controls. However, knowledge was generally poor. New and more effective strategies are required, especially in subgroups identified as having poor knowledge. Clinical Trial Registration— URL: http://www.anzctr.org.au . Unique identifier: ACTRN12608000166370.

We are interested in developing colloidal methods for the synthesis of nanostructures with low overpotentials and high activity for multi-electron, multi-proton electrocatalytic reduction reactions. Ligand etching and intercalation will be offered as two complementary methods for dramatically enhancing the catalytic activity of colloidal transition metal dichalcogenide (TMDC) electrocatalysts. A combination of electrical impedance spectroscopy, structural analysis, and electronic structure characterization will be presented to reveal the mechanisms underlying catalytic improvement in these systems. The extension of these and related post-synthetic methods to tune the activity of colloidal transition metal phosphide electrocatalysts will also be discussed.