Discussion
stroke, death, strokes
ISCHEMIC STROKES, STROKE, EVENT, SENSITIVITY, SECONDARY, ATRIAL FIBRILLATION, EVENTS, STROKES
The MAAESTRO study investigated the intake behaviour of patients with stroke attributable to atrial fibrillation, who are prescribed DOAC for the prevention of recurrent stroke. Specifically, we tested the effect of an intake reminder on adherence to DOAC. The primary outcome (The effect of reminders on adherence was shown in patients using long-term medication [Adherence to DOAC of the MAAESTRO population was already high at about 90%. Other studies that measured adherence to DOAC with electronic monitoring have reported comparable outcomes, although these studies did not specify if participants took DOAC for primary or secondary prevention, nor did they include all four DOAC agents [Sensitivity analyses showed that the chronology in which patients used the reminder did not influence the adherence-enhancing effect of the reminder. In other words, patients who stopped the use of the reminder after 3 months (group 1) and returned to usual settings also returned to a lower level of adherence in the following 3 months. Thus, the adherence-enhancing effect did not persist when the reminder was removed, which is in agreement with previous findings [We investigated the clinical relevance of the study outcomes by means of descriptive statistics because our study was not powered to statistically analyse the effect of improved adherence on ischemic events. We observed that adherence to DOAC was not associated with the occurrence of any clinical vascular event or death. At least, higher adherence seems to be associated with numerically fewer ischemic events, including recurrent ischemic strokes. This observation is in line with other studies that have provided evidence of the positive impact of high adherence on less clinical events in AF patients [Because participants of the MAAESTRO study had experienced mild strokes, they might have presented with hidden dysfunctions that remained undetected with the scales commonly used in clinical practice, such as NIHSS. Nevertheless, patients' ability to manage their medication might be negatively affected by a stroke, independently of its severity [