Secondary prevention adherence falls rapidly after stroke
MedWire News: Many patients stop taking secondary prevention drugs within just 2 years after suffering a stroke, show results from a large Swedish study.
“To prevent new cardiovascular events after stroke, preventive drugs should be used continuously,” said lead researcher Eva-Lotta Glader (Umeå University Hospital, Sweden). “Yet the proportion of patients who were persistent users of drugs prescribed at discharge from hospital declined steadily over the first 2 years.”
Glader and colleagues linked 21,077 patients from the Swedish stroke register Riks-Stroke to the Swedish Prescribed Drug Register. The study “is nationwide, based on objective measures, and reflects drug treatment in clinical practice,” they comment in the journal Stroke.
They report that at 2 years after discharge, just 74.2% of the 15,809 patients prescribed an antihypertensive drug were still taking their medication.
Continued adherence was lower for the 14,904 patients prescribed an antiplatelet agent, at 63.7%, and for the 7275 patients prescribed a statin, at 56.1%. The largest fall in drug use was seen among patients prescribed warfarin, with just 45.0% of 1519 still using the drug after 2 years.
Patients who were living in an institution were 47–78% more likely than those living at home to persist with antihypertensive and antiplatelet drugs and statins, but were 55% less likely to persist with warfarin use.
Patients were more likely to persist with antihypertensives, antiplatelets, and statins if they had good, rather than poor, self-perceived health. Other factors that encouraged drug persistence included being female, having previous stroke or a comorbidity, having been admitted to a stroke unit, and receiving support from relatives.
These findings “support the contention that structural interventions may promote persistent use of secondary prevention drugs,” says the team.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Eleanor McDermid