A Prescription at Discharge Improves Long-term Adherence for Secondary Stroke Prevention

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 9; pp. 2308 - 2315
• Main Authors: Tsai, Jenny P., MD, CM, Rochon, Paula A., MD, Raptis, Stavroula, MSc, Bronskill, Susan E., PhD, Bell, Chaim M., MD, PhD, FRCPC, Saposnik, Gustavo, MD, MSc, FAHA, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Age Factors; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Brain Ischemia - prevention & control; Cardiovascular; Cohort Studies; Databases, Factual; Drug Prescriptions - statistics & numerical data; Female; Follow-Up Studies; Humans; Ischemic stroke; Male; medication; Neurology; outcomes; Patient Compliance - statistics & numerical data; Patient Discharge; Retrospective Studies; Secondary Prevention - statistics & numerical data; Stroke - prevention & control; stroke prevention; Treatment Outcome; medication; Ischemic stroke; outcomes; stroke prevention
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.026

Background Medication adherence is important for optimal secondary stroke prevention. We evaluated short-term adherence to antihypertensive and lipid-lowering agents after a new ischemic stroke, as predictor of adherence at 1 and 2 years. Methods A 5-year cohort of patients from 11 institutions in the Registry of the Canadian Stroke Network was linked to population-based administrative health records. Patients diagnosed with acute ischemic stroke and discharged home were included. Medication adherence was assessed through documented prescription filling at 7 days, 1 year, and 2 years. Results From 2003 to 2008, 6437 ischemic stroke patients were discharged home from hospital, and 1126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of discharge. Patients provided with a prescription at discharge were more likely to show adherence at 7 days. Adherence at 1 year remains higher in these patients for antihypertensive (93.8% vs. 87.7%; odds ratio [OR], 2.31; 95% confidence interval [CI], 1.69-3.16), lipid-lowering agents (88% vs. 81.6%; OR, 1.77; 95% CI, 1.36-2.32), or both (85.8% vs. 79.9%; OR, 1.72; 95% CI, 1.32-2.25). Findings are similar at 2 years for antihypertensive (92.2% vs. 87.7%; OR, 1.78; 95% CI, 1.3-2.43), lipid-lowering agents (82.6% vs. 79.0%; OR, 1.31; 95% CI, 1.01-1.69), or both (81.1% vs. 77.0%; OR, 1.4; 95% CI, 1.09-1.82). Conclusions Provision of a prescription strengthens adherence at 1 week from discharge for both prior and new users of antihypertensive and lipid-lowering drugs. Medication adherence at 1 week after discharge for acute ischemic stroke predicts adherence for secondary preventive therapies at 1 and 2 years.