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Abstract
Objective: Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke–Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge.
Methods: Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines–Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions.
Results: Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence.
Conclusions: Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions.
GLOSSARY
- AVAIL=
- Adherence eValuation After Ischemic stroke–Longitudinal Registry;
- CI=
- confidence interval;
- DCRI=
- Duke Clinical Research Institute;
- EQ5D=
- EuroQOL-5D;
- GWTG-Stroke=
- Get With The GuidelinesSM–Stroke;
- mRS=
- modified Rankin Scale;
- OR=
- odds ratio;
- PCP=
- primary care provider;
- PHQ8=
- Patient Health Questionnaire-8;
- PROTECT=
- Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment.
Footnotes
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Study funding: Funding information is provided at the end of the article.
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Supplemental data at www.neurology.org
- Received January 23, 2011.
- Accepted May 25, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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