Persistence with stroke prevention medications 3 months after hospitalization

Abstract

Objective: To measure longitudinal use of stroke prevention medications following stroke hospital discharge. We hypothesized that a combination of patient-, provider-, and system-level factors influence medication-taking behavior.

Design: Observational cohort design.

Setting: One hundred six US hospitals participating in the American Heart Association Get With The Guidelines-Stroke program.

Patients: Two thousand eight hundred eighty-eight patients 18 years or older admitted with ischemic stroke or transient ischemic attack.

Main outcome measure: Regimen persistence, including use of antiplatelet therapies, warfarin, antihypertensive therapies, lipid-lowering therapies, or diabetes medications, from discharge to 3 months. Reasons for nonpersistence were also ascertained.

Results: Two thousand five hundred ninety-eight patients (90.0%) were eligible for analysis. At 3 months, 75.5% of subjects continued taking all secondary prevention medications prescribed at discharge. Persistence at 3 months was associated with decreasing number of medication classes prescribed, increasing age, medical history, less severe stroke disability, having insurance, working status, understanding why medications are prescribed and how to refill them, increased quality of life, financial hardship, geographic region, and hospital size.

Conclusions: One-quarter of stroke patients reported discontinuing 1 or more of their prescribed regimen of secondary prevention medications within 3 months of hospitalization for an acute stroke. Several modifiable factors associated with regimen persistence were identified and could be targets for improving long-term secondary stroke prevention.

Figure.

Flow diagram of enrollment, follow-up, and analysis for Adherence Evaluation After Ischemic Stroke–Longitudinal (AVAIL) subjects. GWTG indicates Get With The Guidelines program.