A quarter of stroke patients discontinue one or more of their prescribed
secondary stroke prevention medications within 3 months of hospitalization for
an acute stroke, according to a report that will appear in the December issue
of Archives of Neurology.
Each year, there are an estimated 180,000 recurrent strokes in the
United States, according to background in the article. “Reducing the rate
of recurrent stroke requires detecting and treating modifiable risk factors in
the early post-stroke period and developing strategies to improve patient
persistence with medication regimens,” the authors stated.
Cheryl D. Bushnell, MD, MHS, of Wake Forest University Health Sciences,
Winston-Salem, N.C., and colleagues analyzed data from the Adherence Evaluation
After Ischemic Stroke–Longitudinal (AVAIL) Registry to measure secondary
prevention medication persistence in stroke patients from hospital discharge to
3 months. According to the authors, “the assessment of and reasons for
non-persistence at 3 months post-stroke are important because the risk of
recurrent stroke is greatest during this period.”
The authors studied 2,598 patients 18 years or older who had been
admitted to 106 U.S. hospitals with ischemic stroke or transient ischemic
attack. Patients were asked a series of standardized questions regarding their
medication use 3 months after hospital discharge. Those reporting continued use
of a therapy or class of therapies from hospital discharge through 3 months
were described as “persistent.”
The authors found that, “of those treated, 75.5% were persistent
with all the medications prescribed by their physician.” Additionally,
further analysis showed that nearly 20% of patients were taking at least half
of their prescribed medications, while 3.5% of patients were taking none of
their medications at three months.
Multiple factors were associated with persistence in continuing
secondary medication regimens including the presence of cardiovascular disease
and risk factors prior to stroke, having insurance, being prescribed fewer
discharge medications and having an understanding of why these medications were
prescribed and how to refill prescriptions. Additionally, increasing age,
lesser stroke disability and financial hardship were also associated with
persistence in continuing medication regimens.
“The AVAIL Registry showed that medication persistence is
multifactorial. Understanding the complex patient, provider and caregiver
characteristics related to optimal medication-taking behavior in stroke
patients is important,” the authors conclude. “Using the insights
from AVAIL, we can begin to develop and evaluate strategies to improve
appropriate use of evidence-based therapies and reduce the risk of recurrent
stroke.”
