Abstract TMP56: Are Depressed Stroke Survivors Less Likely to Be Adherent to Secondary Prevention Therapies?

Abstract

Introduction: Depression is common after ischemic stroke (IS). Stroke survivors who are depressed are at greater risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. However, how depression leads to poor IS outcomes is unclear and few studies have shown an association between depression after stroke and healthcare use. Objective: To evaluate the impact of depression on medication adherence after stroke. Methods: We analyzed the multicenter database comprising information drawn from electronic medical records and pharmacy records (Healthconnect, POINT). All ischemic stroke patients presenting to one of 11 medical centers within a health maintenance organization in California between January 1, 2007 and June 30, 2015 with at least 2 medication fills for a stroke prevention medication and six months of information were evaluated. Adherence was calculated for antihypertensive, hypoglycemic, and lipid lowering medications, but not for antiplatelet or anticoagulant medications as the latter may be obtained over the counter, or with variable daily dosing, which would bias adherence calculations. Adherence was calculated by using the continuous medication gap (CMG) methodology, which determines the cumulative period that no medication was available to the patient. The number of days for which the patient did not have the medication was divided by the number of days in the study window for that patient. Results: There were 9933 patients with ischemic stroke during the study period. Of these, 2019 had a diagnosis of depression made after the index stroke. Among the non-clinically depressed patients the CMG adherence was 0.22 (Standard Deviation +/- 0.29), while among clinically depressed patients it was 0.28 (SD +/-0.32, p<0.0001). Conclusions: Ischemic stroke survivors diagnosed with depression after an index stroke are overall 26% less likely to be adherent to key secondary prevention drugs than their non-depressant counterparts. Poor medication adherence among depressed stroke patients may be an important contributor to their relatively poorer clinical outcomes.