Related Experiment Videos

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

Neurology
|September 9, 2011
PubMed

Insights

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.

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.
Abstract

Related Concept Videos

Drug Therapy01:28

Drug Therapy

The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Atherosclerosis IV: Nursing Management01:23

Atherosclerosis IV: Nursing Management

Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...