Secondary preventive medication persistence and adherence 1 year 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.