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Secondary preventive medication persistence and adherence 1 year after stroke.

C D Bushnell¹, D M Olson, X Zhao

¹Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. cbushnel@wakehealth.edu

|September 9, 2011

Summary

Many stroke patients stop secondary prevention medications within a year, but self-discontinuation is rare. Modifiable patient, provider, and system factors may improve medication persistence and adherence after stroke.

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Area of Science:

Cardiovascular Medicine
Neurology
Public Health

Background:

Long-term data on secondary prevention medication use post-stroke are scarce.
Understanding factors influencing medication continuation is crucial for stroke recovery.

Purpose of the Study:

To assess patient, provider, and system-level factors affecting secondary prevention medication continuation for one year after ischemic stroke hospitalization.
To evaluate medication persistence and adherence in stroke survivors.

Main Methods:

The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry surveyed 2,880 ischemic stroke patients from 106 hospitals.
Medication use (warfarin, antiplatelet, antihypertensive, lipid-lowering, diabetes) was tracked for 12 months post-discharge.
Persistence (all meds continued) and adherence (meds continued as instructed) were defined and analyzed.

Main Results:

65.9% of patients were regimen persistent, and 86.6% were regimen adherent at 1 year.
Fewer discharge medications, adequate income, primary care appointments, and better medication understanding predicted persistence.
Adherence predictors were similar to persistence predictors.

Conclusions:

Up to one-third of stroke patients discontinued at least one secondary prevention medication within a year.
Self-discontinuation was uncommon, suggesting provider or system issues may play a role.
Modifiable patient, provider, and system factors offer targets for future interventions to improve long-term medication use.