Abstract
BackgroundMedication nonadherence can be as high as 50% and results in suboptimal patient outcomes. Stroke patients in particular can benefit from pharmacotherapy for thrombosis, hypertension, and dyslipidemia but are at high risk for medication nonpersistence.MethodsPatients who were admitted to the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, with stroke between January 1, 2001 and December 31, 2002 were analyzed. Data collected were pre-stroke function, stroke subtype, stroke severity, patient outcomes, and medication use at discharge, and six and 12 months post discharge. Medication persistence at six and 12 months and the factors associated with nonpersistence at six months were examined using multivariable stepwise logistic regression.ResultsAt discharge, 420 patients (mean age 68.2 years, 55.7% male) were prescribed an average of 6.4 medications and mean prescription drug cost was $167 monthly. Antihypertensive (91%) and antithrombotic (96%) drug use at discharge were frequent, antilipidemic (73%) and antihyperglycemic (25%) drug use were less common. Self-reported persistence at six and 12 months after stroke was high (> 90%) for all categories.In the multivariable model of medication nonpersistence at six months, people aged 65 to 79 years were less likely to be nonpersistent with antihypertensive medications than people aged 80 years or more (Odds ratio (OR) 0.11, 95% Confidence Interval (CI) 0.03–0.39). Monthly drug costs of < $90 or $90–199.99 were associated with greater nonpersistence, compared to monthly drug costs ≥$200 (OR 6.74, 95% CI 1.32–34.46 for < $90; OR 5.25, 95% CI 1.14–24.25 for $90–199.99). For the antithrombotic drug category, people aged 65 to 79 years were less likely to be nonpersistent than people aged 80 years or more (OR 0.23, 95% CI 0.06–0.81), and people who were disabled before admission were more likely to be nonpersistent than those not disabled (OR 7.01, 95% CI 1.66–29.58).ConclusionPatients reported high medication persistence rates six and 12 months after stroke. Identification of factors associated with nonpersistence (such as older age and prior disability) will help predict which patients are at higher risk for discontinuing their medications.
Highlights
Medication nonadherence can be as high as 50% and results in suboptimal patient outcomes
Identification of factors associated with nonpersistence will help predict which patients are at higher risk for discontinuing their medications
Risk factor management in stroke patients has been the subject of numerous randomized clinical trials and meta-analyses of these trials. [2,3,4,5,6,7,8,9,10,11,12,13] These studies have shown that for people with atrial fibrillation and previous transient ischemic attack (TIA), anticoagulant use can reduce recurrent stroke by two-thirds, and all vascular events can be reduced by one-half.[6]
Summary
Medication nonadherence can be as high as 50% and results in suboptimal patient outcomes. Persons recovering from a stroke or transient ischemic attack (TIA) are at high risk for recurrent stroke, disability, institutionalization, and death.[2] Pharmacotherapy that targets hypertension, vascular disease, and hyperlipidemia can decrease the risk of further vascular events and mortality.[2] Risk factor management in stroke patients has been the subject of numerous randomized clinical trials and meta-analyses of these trials. Statins (a family of lipid-lowering agents such as atorvastatin and simvastatin) have been shown to produce an approximate 25% relative risk reduction of stroke in patients with a history of stroke or TIA.[10,11]
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