Nearly 800,000 patients suffer from ischemic strokes in the United States each year. They are currently treated with several different types of medicines (antiplatelet agents, anticoagulants such as warfarin, antihypertension drugs, lipid-lowering medications, and medications for diabetes) to reduce their risk of future strokes.
Two studies supported by the Agency for Healthcare Research and Quality (HS16964) found that discontinuation of these medications is uncommon, with no difference among rural and urban residents. Both studies used the AVAIL (Adherence eValuation After Ischemic stroke-Longitudinal) national patient registry to examine adherence to these stroke-prevention medications nationally and among rural residents. The registry included patients enrolled from July 2006 through July 2008 at 101 hospitals that were participants in the American Heart Association's Get With The Guidelines—Stroke Program. The patients or their proxies (a family member or caregiver) were interviewed at 3 months and 12 months after hospital discharge.
The studies are briefly described here.
Bushnell, C.D., Olson, D.M., Zhao, X., and others (2011). "Secondary preventive medication persistence and adherence 1 year after stroke." Neurology 77(12), pp. 1182-1190.
The researchers enrolled 2,880 patients from 101 sites, which resulted in a study population of 2,457 patients followed for 12 months. At 12 months, 65.6 percent of the patients persistently took their prescribed medications. Factors associated with regimen persistence included a history of high blood pressure or high blood-lipid levels, fewer medicines prescribed at discharge, having adequate income, and having a followup appointment with a primary care provider. By drug class, the highest 12-month persistence was for antihypertensive medications (87.9 percent), followed by antiplatelet (87.1 percent), diabetes (82.3 percent), and lipid-lowering medications (77.6 percent). Factors associated with adherence, but not persistence, included use of a pillbox, medication insurance, having received medication instructions, being married, and being discharged to home.
Rodriguez, D., Cox, M., Zimmer, L.O., and others (2011). "Similar secondary stroke prevention and medication persistence rates among rural and urban patients." The Journal of Rural Health 27(4), pp. 401-408.
The AVAIL investigators analyzed the impact of being a rural or urban resident on persistence and adherence to taking medications to prevent another stroke, because rural residents are known to be less likely to receive optimal care or have good outcomes for serious conditions. There was essentially no difference between the two groups regarding the type of stroke they suffered. Although rural patients were less likely than urban patients (73.0 vs. 77.8 percent) to be given antihypertensive medication at discharge, they were just as likely to show 12-month regimen or drug-class persistence. The 426 rural patients (ZIP code not part of a metropolitan statistical area) were slightly younger (median age 66 versus 67 years), and were more likely to be white, married, and smokers than the 2,294 urban patients. Rural patients were also less likely to be college graduates (35.2 vs. 43.4 percent). Most rural patients received care at urban hospitals, but they were more likely to be admitted to a smaller hospital and hospitals that treated fewer stroke patients annually.