Abstract
Introduction
Prior stroke is one of the biggest risk factors for future stroke events. Secondary prevention medications are key to reducing subsequent vascular events, and guidelines recommend use of antithrombotics, antihypertensives and lipid lowering drugs. We carried out a retrospective study of adherence to these medications in a post stroke population.
Methods
Consecutive patients admitted with acute stroke to a Dublin hospital between July 2022 and November 2023 were invited to participate. Participant interviews were carried out at 1 year post stroke, including demographic and clinical information and care needs. Functional ability was graded using the Modified Rankin Scale (mRS). Adherence to three key categories of secondary preventative drugs was assessed using the 4-item Morisky Medication Adherence Scale, and participants were asked to show all current medications, which were compared to the discharge prescription.
Results
Interviews were conducted with 197 participants at 1 year post stroke. Mean age was 68.8 years, 66% were male and 79% were of white Irish ethnicity. Twelve (6%) were living in nursing homes while 68% were functionally independent with mRS 0-2. High adherence to all prescribed medicines was reported by 79% and was higher for antihypertensives and antithrombotics (87%) than for lipid-lowering drugs (78%). There was no statistically significant difference in self-reported adherence between gender or race subgroups. Adherence was better in participants who were functionally dependent by mRS (71% vs 97%, p<0.0001) and those who had an involved caregiver (69% vs 89%, p<0.0001).
Discussion
Self-reported adherence to medication was high in this cohort but a significant proportion were not adherent to important secondary prevention medications 1 year after a stroke. Adherence was higher for those who had more disabling strokes and an involved caregiver. We did not find any difference between race or gender groups.