Study: 25% of stroke patients discontinue therapy after discharge

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One-quarter of stroke patients discontinue one or more of their prescribed medications for secondary prevention within three months of a hospitalization. And several factors such as insurance, finances and older age may be the culprit, according to research from the AVAIL registry published online Aug. 9 in the Archives of Neurology.

Each year, an estimated 180,000 recurrent strokes occur in the U.S. “Reducing the rate of recurrent stroke requires detecting and treating modifiable risk factors in the early post-stroke period and developing strategies to improve patient persistence with medication regimens,” the authors wrote.

Cheryl D. Bushnell, MD, of Wake Forest University Health Sciences in Winston-Salem, N.C., and colleagues observed 2,888 patients who were admitted for ischemic stroke or transient ischemic attack at 106 hospitals participating in the American Heart Association’s Get with the Guidelines-Stroke initiative across the U.S.

The researchers analyzed data from the Adherence Evaluation After Ischemic Stroke Longitudinal (AVAIL) registry. The primary endpoints were regimen persistence including antiplatelet use, warfarin therapy, antihypertensives, lipid-lowering therapy or diabetes therapy from discharge to three months subsequent to hospitalization.

“The assessment of and reasons for non-persistence at three months post-stroke are important because the risk of recurrent stroke is greatest during this period,” the authors wrote.

Researchers obtained the reasons for patients’ discontinuation of therapy via a list of standard questions regarding medication use during the three-month time period.

The results showed that 75.5 percent of patients continued to take secondary prevention therapy prescribed at discharge—classified as “persistent.”

The researchers found that 20 percent of patients were taking half of their prescribed medications and 3.5 percent stopped taking all prescriptions three months after discharge.

Factors such as the presence of cardiovascular disease, prior risk factors of stroke, insurance coverage, being prescribed fewer medications and understanding why the prescriptions are necessary lead to the persistent continuation of secondary medication regimens.

“Understanding the complex patient, provider and caregiver characteristics related to optimal medication-taking behavior in stroke patients are important,” the authors concluded. “Using the insights from AVAIL, we can begin to develop and evaluate strategies to improve appropriate use of evidence-based therapies and reduce the risk of recurrent stroke.”