Prestroke Medication Adherence and its Clinical Significance in Patients With Ischemic Stroke: Single Hospital-Based Study

ABSTRACT

BACKGROUND: Medication adherence (MA) is poor among patients with chronic illnesses, such as those involving the risk factors of stroke. However, the impacts of poor MA on the modifiable risk factors of stroke are not well known. METHODS: We evaluated the MA for the control of hypertension, diabetes, hyperlipidemia, and previous ischemic stroke among consecutive patients with ischemic stroke within 7 days of symptom onset. Nonadherence was defined as taking doctor-prescribed medications for less than 3 weeks during the previous month. Demographic data, risk factor profile, stroke mechanism, and baseline score on the National Institutes of Health Stroke Scale (NIHSS) were compared among patients with nonadherence and those without. RESULTS: Among 1133 patients with at least one medicated risk factor, the rates of nonadherence in hypertension, diabetes, hyperlipidemia, and previous ischemic stroke were 18.5%, 15.3%, 30.3%, and 28.1%, respectively. Overall, 27.4% of patients with more than one risk factor presented nonadherence, with a predilection toward being male (male, 63.9% vs. female, 56.1%, p=0.02) and younger (mean age 64.9 years vs. 66.4 years, p=0.01). Stroke severity according to MA did not differ using either crude analysis (NIHSS score 5.5+/-5.9 vs. 5.4+/-5.5, p=0.71) or multivariable analysis after log transformation. The prevalence of nonadherence was low for large-artery disease and small-vessel occlusion, and high for cardioembolism. CONCLUSIONS: Prestroke poor MA for the major risk factors was common among patients with chronic illnesses, and was more frequent in younger male patients. Stroke severity was not affected by MA during the month preceding stroke.