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Many Stroke Patients Discontinue Medications Prescribed to Prevent Recurrence

Bushnell CD, Zimmer LO, Pan W, Olson DM, Zhao X, Meteleva T, Schwamm L, Ovbiagele B, Williams L, Labresh KA, Peterson ED; for the Adherence Evaluation After Ischemic Stroke–Longitudinal Investigators. Arch Neurol.. 2010 Aug 9. [Epub ahead of print] PMID: 20697032

By Kim L. Farina, PhD

About one out of four acute stroke patients stopped taking one or more of the medications prescribed to them to prevent recurrent stroke during the period when their chance of having another stroke is highest.

Nearly 200,000 recurrent strokes occur in the United States each year, accounting for more than 25% of the overall number of strokes that occur annually.

Investigators interviewed 2,888 patients recruited from 106 hospitals participating in the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke (GWTG-Stroke) program. The GWTG-Stroke program was developed to facilitate the measurement, tracking, and improvement in quality of care and outcomes for acute stroke and transient ischemic attack (TIA) patients in the United States. Over 1,400 hospitals across the nation participate in this registry program, enrolling more than 1,000,000 patients. The AVAIL (Adherence Evaluation After Ischemic Stroke-Longitudinal) Registry study followed up with consenting patients from these hospitals at 3 and 12 months post hospital discharge.  The aim of the AVAIL Registry study was designed to measure patient persistence in continuing their prescribed secondary prevention medication regimens following hospitalization for acute stroke or TIA.

Results of the analyses showed that of the ischemic stroke or transient ischemic attack patients interviewed, nearly 25% stopped taking one or more of their prescribed secondary prevention medications within 3 months of hospital discharge. "The assessment of and reasons for nonpersistence at 3 months post-stroke are important because the risk of recurrent stroke is greatest during this period," according to the study authors.

Factors associated with continuation of secondary prevention medications included:

  • having lower number of medication classes prescribed,
  • increasing age,
  • having insurance,
  • understanding why medications were prescribed and how to get refills,
  • having milder disability from stroke,
  • self-reporting higher quality of life,
  • experiencing fewer financial hardship, and
  • having cardiovascular disease (prior MI or coronary artery disease) or risk factors (hypertension, diabetes, or dyslipidemia) prior to stroke.

Many of these factors are considered modifiable and could serve as future targets of secondary stroke prevention efforts.

Lead author on the study, Cheryl D. Bushnell, M.D., M.H.S., explained that patients are often not discontinuing their medications on their own, but rather their provider is discontinuing them. "I think that a lot of patients will tell their doctors that the medication doesn't agree with them or they can't take it for some other reason and the doctor takes them off of it," Bushnell said. "Many doctors try to limit the number of medications a patient has to take, especially when a lot of the same medicines can be used to treat both stroke and coronary disease."

The results of this study were published online in the Archives of Neurology and were also featured in the New York Times Health Section. The researchers' next analysis will reveal the compliance results one year after hospital discharge.

Data analyses were performed by the Duke Cardiovascular Center for Education and Research on Therapeutics (CERTs) at the Duke Clinical Research Institute. The AVAIL registry was funded by BMS/Sanofi Pharmaceutical Partnership. Analyses were supported by CERTs funding from the Agency for Healthcare Research and Quality.

References

  1. Bushnell CD, Zimmer LO, Pan W, et al; for the Adherence Evaluation After Ischemic Stroke-Longitudinal Investigators. Persistence With Stroke Prevention Medications 3 Months After Hospitalization. Arch Neurol 2010 Aug 9. [Epub ahead of print] PMID: 20697032.
  2. Bushnell C, Zimmer L, Schwamm L, et al; AVAIL registry. The Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) registry: design, rationale, and baseline patient characteristics. Am Heart J 2009;157(3):428-435.e2. PMID: 19249411

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Page last reviewed March 2017
Page originally created March 2017

Internet Citation: Many Stroke Patients Discontinue Medications Prescribed to Prevent Recurrence. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD.
https://archive.ahrq.gov/chain/research-tools/featured-certs/stroke-patients-discontinue-medications.html

 

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