At least a quarter of patients who have suffered a stroke stop taking one or more of their prescribed stroke prevention medications within the first three months after being hospitalized when the chance of having another stroke is highest as per a newly released study by scientists at Wake Forest University Baptist Medical Center and his colleagues.

Each year, there are an estimated 180,000 recurrent strokes in the United States. The study identified several modifiable factors that are linked to stroke survivors' compliance in taking medicine that can help prevent recurrent stroke. Scientists hope those factors will prove effective targets for improving compliance.

The paper appears online this week in the Archives of Neurology, one of the JAMA/Archives journals, and is scheduled to appear in the journal's December print issue.

"There is very little known about how stroke patients feel about their medications and all of the complicated reasons that people may or may not stay on those medications," said Cheryl D. Bushnell, M.D., M.H.S., an associate professor of neurology at Wake Forest Baptist and main author on the study. "Physicians can prescribe all of the right medications, but if patients don't take them, they're not receiving the benefits of prevention".

So, Bushnell and his colleagues, including scientists at Duke Clinical Research Institute, designed a study similar to those done to investigate medicine compliance in patients with coronary artery disease. They looked at compliance issues from the patients' perspective, as well as system and provider issues, such as what type of doctor the patients saw, what kind of follow-up care they had and the patients' understanding of their medications and why they were taking them.

The scientists studied 2,598 patients from the Adherence Assessment After Ischemic StrokeLongitudinal (AVAIL) Registry to evaluate how a number of stroke patients continued taking their prescribed medications to prevent a second stroke three months after their discharge from the hospital. The chance of a second stroke, the authors noted, is greatest during the first three months after the initial attack.

The authors observed that about 75 percent of those studied had continued with their full regimen of medications commonly including an aspirin or other type of blood thinner, blood pressure medicine and cholesterol lowering medicine three months after discharge. But they also observed that nearly 20 percent of patients had stopped taking one or more of their prescribed medications, while 3.5 percent of patients weren't taking any of their medications at three months.

"This is actually much better than what we would expect based on our clinical experience," Bushnell said. "It's surprising at how high the compliance rate was. As physicians, we often see a lot more patients stopping their medicine on their own or having it stopped by a physician, so we think this may have been a best-case scenario, but it's still concerning. That's a lot of people at high risk of having a second stroke who are not doing everything they can to prevent it." Bushnell explained that the participating hospitals were all involved in quality improvement activities for stroke care, so they were highly motivated to have good stroke outcomes. It is possible that the patients at these hospitals were seen for their follow-up appointments by the same doctor who prescribed the medications at discharge, unlike a number of hospitals where follow-up care is handled by the patient's normal doctor.

Scientists learned from the study that multiple factors were linked to persistence in continuing secondary medicine regimens, including the presence of cardiovascular disease and risk factors previous to stroke, having insurance, having a better quality of life, being prescribed fewer discharge medications and having an understanding of why these medications were prescribed and how to refill them. Additionally, increasing age, lesser stroke disability and fewer financial hardships were also linked to persistence in continuing medicine regimens.

Bushnell also explained that a number of times, patients aren't discontinuing their medications on their own, but rather their doctors appears to be discontinuing them.

"I believe that a lot of patients will tell their doctors that the medicine doesn't agree with them or they can't take it for some other reason and the doctor takes them off of it," Bushnell said. "A number of doctors try to limit the number of medications a patient has to take, particularly when a lot of the same medicines can be used to treat both stroke and coronary disease".

In fact, patients who had a diagnosis of coronary disease or some other chronic disease before their stroke and were accustomed to taking daily medications to treat that condition were more likely to continue taking their new medications after stroke, the study showed.

"Patients who are taken off-guard by a stroke, and are given a lot of new medications and a new diagnosis, can get a little overwhelmed and the result can be discontinuation of one or more medications," she said. "But we learned that patients who actually understand why they are being prescribed each new medicine and how to go about refilling their prescriptions are more compliant. This is a really important teaching moment. We, as doctors, need to make sure we are giving patients more specific information upon discharge. We need to explain things in more detail, such as, 'This blood pressure medicine we're asking you to take isn't just for lowering your blood pressure, it's for preventing another stroke.'.

"This study has really changed the way I interact with my patients," Bushnell added. "I've started asking the sometimes uncomfortable questions about whether they can afford their medications and if they're taking them. If they aren't, I'm asking why. My passion is to try to prevent recurrent stroke and to understand the patients' and caregivers' perspectives and the barriers and areas we can intervene in to make sure that people have the knowledge and resources to keep taking their medicines. Hopefully, we as providers can improve patients' medicine compliance through better communication and by being aware of the factors linked to medicine discontinuation".

The researchers' next study will reveal the compliance results one year after hospital discharge.


Posted by: Emily    Source

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