Age, disability among indicators of medication adherence 3 months after stroke

Age, stroke-related disability, and several other factors indicate whether a patient will continue adhering to discharge medications three months after a stroke, a new study has found.

The AVAIL (Adherence Evaluation After Ischemic Stroke–Longitudinal) investigators analyzed data from hospitals participating in the Get with the Guidelines–Stroke program to determine what variables were associated with long-term medication adherence after hospital discharge for stroke. The main outcome measures were regimen persistence from discharge to three months for five classes of medications (antiplatelet therapies, warfarin, antihypertensive therapies, lipid-lowering therapies or diabetes medications) and reasons for nonpersistence. The study results were published online Aug. 9 by Archives of Neurology.

Overall, 2,598 patients at 106 U.S. hospitals were included in the study analysis. Of these, 75.5% continued to take all of the stroke prevention medications prescribed at discharge three months later. Patients were most likely to continue taking antihypertensive and antiplatelet medications. Patients who were older, had less severe stroke-related disability, had been prescribed fewer discharge medications, and had insurance were more likely to continue taking their medications. Patients who understood why they were taking the medications and how to get them refilled were also more likely to take them long-term. Better quality of life, greater financial hardship, working status, geographic region and hospital size were also associated with adherence at three months.

The authors noted that although about three-quarters of patients did continue taking their stroke prevention medications three months after discharge, about a quarter did not. They also pointed out that rates might be worse at hospitals not participating in Get with the Guidelines, which might not be as focused on stroke care. Although their study had limitations, including limited generalizability, use of self-reported data, and lack of information on clinician visits at three months, they concluded that long-term adherence to stroke medications depends on many factors, some of them modifiable. Using their data, they wrote, “We can begin to develop and evaluate strategies to improve appropriate use of evidence-based therapies and reduce the risk of recurrent stroke.”