One in 4 Stroke Patients Don’t Take Their Meds

After a stroke, the important thing (apart from rehab) is to prevent having another stroke.  To this end, a number of different medications are usually prescribed.  However, quite a few people don’t take all their meds, thus running a much greater risk of another stroke, or ‘incident’.  This was recently quantified in a study done by Wake Forrest University scientists in Winston Salem, North Carolina.  Their findings are posted online in the Archives of Neurology. 

106 US hospitals participating in the American Heart Association “Get with the Guidelines – Stroke” program provided data on 2,888 patients hospitalized for stroke or TIA (transient ischemic attack, or mini-stroke).  The patients were contacted 3 months after discharge from hospital and asked about their persistence in taking prescribed meds.  The meds were classified into antiplatelet drugs, warfarin, anti-blood pressure, lipid-lowering, and anti-diabetic drugs.  If they had stopped taking one or more meds, they were asked whether they chose to stop themselves and their reason for this, or if they were instructed to do so by a physician.  There were close to 2,600 replies that could be used for analysis.

Less than 1% of the respondents were discharged without a prescription for any of the classes of medication.  23% had 2, 44% had 3 and 23% had 4 such meds prescribed.  Of those treated, 75.5% were still taking all their prescribed drugs (i.e. were ‘persistent’) at the 3-month interval.

In most cases of discontinuation, it was a physician who did this;  reasons were not elicited in such cases.  The patient factors associated with persistence in taking medication were:  having medical insurance, understanding the reasons for their meds, and knowing how to get refills.  Older patients were more likely to be persistent, and have existing cardiovascular disease, diabetes, or high cholesterol levels.  Mild disability from their stroke (compared with moderate or severe) was also found to correlate with persistence in medication.

One in 4 non-compliant patients may seem a high proportion, but two experts have both indicated that this was a better ratio than they would expect.  It’s important, however, to concentrate on improved patient and caregiver education, including follow-up, if the 25% are to be given the best chance of avoiding another stroke or cardiovascular event.