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 journalArticlepeer-review

204 Scopus citations

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

Bibliographical note

Funding Information:
Adherence eValuation After Ischemic stroke—Longitudinal (AVAIL) was supported by unrestricted funds from Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership and conducted through collaboration with the GWTG-Stroke program. AVAIL analyses were also supported in part by the Agency for Healthcare Research and Quality (AHRQ) cooperative agreement U18HS016964. DCRI developed the protocol, owns the data, and is responsible for study oversight, materials development and data collection, site communications, and all regulatory and clinical questions related to the AVAIL Registry study.

Funding Information:
Dr. Bushnell serves on a data safety monitoring board for Boehringer Ingelheim; and received research support from the Bristol-Myers Squibb/Sanofi Partnership, the NIH/NINDS, the American Heart Association/Bugher Foundation, and the Hazel K Goddess Fund for Research on Stroke in Women. Dr. Olson serves on speakers' bureaus for and has received speaker honoraria from Zoll Medical, Integra Neuroscience, and The Medicines Company; and has received research support from the Bristol-Myers Squibb/Sanofi Partnership. X. Zhao and Dr. Pan report no disclosures. L. Zimmer receives research support from AHRQ and holds stock in Abbott. Dr. Goldstein serves on a scientific advisory board for Allergan; has received funding for travel and speaker honoraria from Bayer Schering Pharma; serves on the editorial boards of Neurology®, Emergency Medicine, Stroke, Cerebrovascular Diseases, and Circulation: Cardiovascular Quality and Outcomes and as an Associate Editor for Continuum; receives publishing royalties from UpToDate and Henry Stewart Talks; serves as a consultant for Pfizer Inc, Boehringer Ingelheim, Johnson & Johnson, and Merck Serono; receives research support to his institution from Pfizer Inc, AGA Medical Corporation, and Abbott; and receives research support from the NIH, the American Heart Association, and El Centro Hispano. Dr. Alberts serves on a scientific advisory board, as a consultant, and on the speakers' bureau for and has received funding for travel and speaker honoraria from the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; receives publishing royalties from Blackwell Publishing; and has received royalties from Athena Diagnostics, Inc. re: apoE genetic testing. Dr. Fagan serves on scientific advisory boards for Pfizer Inc and Genentech, Inc.; serves on the editorial board of Pharmacotherapy; serves as a consultant for Pfizer Inc, Genentech, Inc, and Ferrer Group; and receives research support from the NIH/NINDS and the US Veterans Administration. Dr. Fonarow serves as a consultant for Novartis and Pfizer Inc. Dr. Johnston is co-holder of patent re: the RNA panel to identify TIA and risk stratify; and receives research support from sanofi-aventis, Strkyer Neurovascular, Boston Scientific, the NIH (NCRR, NINDS), Kaiser-Permanente, and the AHA/ASA, Bugher Award. Dr. Kidwell serves on the editorial boards of Neurocritical Care, the Journal of Neuroimaging, and Stroke Research and Treatment; serves/served as a consultant for Embrella Cardiovascular, Inc., and Simcere Pharmaceutical Group; and receives research support from Baxter International Inc. and the NIH/NINDS. Dr. LaBresh reports no disclosures. Dr. Ovbiagele serves on a scientific advisory board for Avanir Pharmaceuticals and serves as an Assistant Editor of Stroke, an Associate Editor of Journal Watch Neurology and BMC Public Health, and on the editorial boards of the Journal of Stroke and Cerebrovascular Diseases and Stroke Research and Treatment. Dr. Schwamm serves as chair of the American Heart Association GWTG Steering Committee; serves on scientific advisory boards for CoAxia, Inc., Phreesia, and Lundbeck Inc.; serves on the editorial boards of Neurocritical Care and Stroke; may accrue revenue on a patent re: Imaging system for obtaining quantitative perfusion indices; his wife receives royalties from publishing Obstetric Anesthesia (Cambridge Pocket Clinicians, 2007); serves/has served as a consultant to CryoCath® Technologies Inc., Research Triangle Inc., Massachusetts Department of Public Health, and the Canadian Stroke Network; receives research support from Lundbeck Inc., the NIH (NINDS, NCRR), and the Department of Health and Human Services (CDC); and has provided expert medical opinions in malpractice lawsuits (re: stroke treatment and prevention). Dr. Peterson serves on the editorial board of the Journal of the American Medical Association and receives research support from Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership and Merck Serono.

ASJC Scopus subject areas

  • Clinical Neurology

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