Prescription at discharge linked to long-term adherence to stroke meds

Stroke patients are 70% more likely to continue taking their stroke prevention medications 1 year later if they are given a prescription when discharged, and 40% more likely after 2 years, according a study published in the Journal of Stroke and Cerebrovascular Diseases. 

“We found that a provision of a prescription before discharge improved adherence for secondary stroke preventive therapies [eg, blood pressure and cholesterol lowering medications] at 1 and 2 years,” said study author Gustavo Saposnik, MD, director of the Stroke Research Unit of St. Michael's Hospital, Toronto, Canada.

In the study, a 5-year (from 2003 to 2008) cohort of patients from 11 institutions in the Registry of the Canadian Stroke Network was linked to population-based administrative health records. Patients diagnosed with acute ischemic stroke and discharged home were included. Medication adherence was assessed through documented prescription filling at 7 days, 1 year, and 2 years.

According to the authors 6,437 ischemic stroke patients were discharged home from hospital, and 1,126 patients filled a prescription for antihypertensive and lipid-lowering agents within 7 days of discharge. Adherence at 1 year was higher in these patients for antihypertensive (93.8% vs. 87.7%; odds ratio [OR], 2.31; 95% CI, 1.69-3.16), lipid-lowering agents (88% vs. 81.6%; OR, 1.77; 95% CI, 1.36-2.32), or both (85.8% vs. 79.9%; OR, 1.72; 95% CI, 1.32-2.25). Findings were similar at 2 years for antihypertensive (92.2% vs. 87.7%; OR, 1.78; 95% CI, 1.3-2.43), lipid-lowering agents (82.6% vs. 79.0%; OR, 1.31; 95% CI, 1.01-1.69), or both (81.1% vs. 77.0%; OR, 1.4; 95% CI, 1.09-1.82).

“Our findings are relevant to enforce that a simple strategy like a provision of a prescription for those medications before discharge are likely to improve the continuation-adherence to treatment-known to be associated to decrease the risk of a future stroke, said Dr Saposnik.

According to the Heart and Stroke Foundation, there are an estimated 50,000 strokes in Canada each year. 

“A simple strategy during the hospitalization may have significant impact in the long-term risk of a recurrent cardiovascular events,” he said. “There was some information from the United States suggesting a low adherence to those medications after 1 or 2 years following a stroke. We were interested in evaluating the situation in Ontario where medications are usually covered after age 65.”

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