Secondary preventive medication persistence and adherence 1 year after stroke

C. D. Bushnell, D. M. Olson, X. Zhao, W. Pan, L. O. Zimmer, L. B. Goldstein, M. J. Alberts, S. C. Fagan, G. C. Fonarow, S. C. Johnston, C. Kidwell, K. A. LaBresh, B. Ovbiagele, L. Schwamm, E. D. Peterson

Research output: Contribution to journalArticle

142 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1182-1190
Number of pages9
JournalNeurology
Volume77
Issue number12
DOIs
StatePublished - Sep 20 2011

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Medication Adherence
Stroke
Secondary Prevention
Warfarin
Persistence
Adherence
Medication
Health Personnel
Antihypertensive Agents
Registries
Primary Health Care
Appointments and Schedules
Hospitalization
Guidelines
Interviews
Lipids

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Bushnell, C. D., Olson, D. M., Zhao, X., Pan, W., Zimmer, L. O., Goldstein, L. B., ... Peterson, E. D. (2011). Secondary preventive medication persistence and adherence 1 year after stroke. Neurology, 77(12), 1182-1190. https://doi.org/10.1212/WNL.0b013e31822f0423

Secondary preventive medication persistence and adherence 1 year after stroke. / Bushnell, C. D.; Olson, D. M.; Zhao, X.; Pan, W.; Zimmer, L. O.; Goldstein, L. B.; Alberts, M. J.; Fagan, S. C.; Fonarow, G. C.; Johnston, S. C.; Kidwell, C.; LaBresh, K. A.; Ovbiagele, B.; Schwamm, L.; Peterson, E. D.

In: Neurology, Vol. 77, No. 12, 20.09.2011, p. 1182-1190.

Research output: Contribution to journalArticle

Bushnell, CD, Olson, DM, Zhao, X, Pan, W, Zimmer, LO, Goldstein, LB, Alberts, MJ, Fagan, SC, Fonarow, GC, Johnston, SC, Kidwell, C, LaBresh, KA, Ovbiagele, B, Schwamm, L & Peterson, ED 2011, 'Secondary preventive medication persistence and adherence 1 year after stroke', Neurology, vol. 77, no. 12, pp. 1182-1190. https://doi.org/10.1212/WNL.0b013e31822f0423
Bushnell, C. D. ; Olson, D. M. ; Zhao, X. ; Pan, W. ; Zimmer, L. O. ; Goldstein, L. B. ; Alberts, M. J. ; Fagan, S. C. ; Fonarow, G. C. ; Johnston, S. C. ; Kidwell, C. ; LaBresh, K. A. ; Ovbiagele, B. ; Schwamm, L. ; Peterson, E. D. / Secondary preventive medication persistence and adherence 1 year after stroke. In: Neurology. 2011 ; Vol. 77, No. 12. pp. 1182-1190.
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AU - Olson, D. M.

AU - Zhao, X.

AU - Pan, W.

AU - Zimmer, L. O.

AU - Goldstein, L. B.

AU - Alberts, M. J.

AU - Fagan, S. C.

AU - Fonarow, G. C.

AU - Johnston, S. C.

AU - Kidwell, C.

AU - LaBresh, K. A.

AU - Ovbiagele, B.

AU - Schwamm, L.

AU - Peterson, E. D.

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N2 - 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.

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