Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

1 in 4 stroke patients stop taking prevention medication within 3 months

12.08.2010
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 – according to a new study by researchers at Wake Forest University Baptist Medical Center and colleagues.

Each year, there are an estimated 180,000 recurrent strokes in the United States. The study identified several modifiable factors that are associated with stroke survivors' compliance in taking medication that can help prevent recurrent stroke. Researchers 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 lead 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 colleagues, including researchers at Duke Clinical Research Institute, designed a study similar to those done to investigate medication 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 researchers studied 2,598 patients from the Adherence Evaluation After Ischemic Stroke–Longitudinal (AVAIL) Registry to evaluate how many 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 found that about 75 percent of those studied had continued with their full regimen of medications – usually including an aspirin or other type of blood thinner, blood pressure medication and cholesterol lowering medication – three months after discharge. But they also found 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 many hospitals where follow-up care is handled by the patient's normal doctor.

Researchers learned from the study that multiple factors were associated with persistence in continuing secondary medication regimens, including the presence of cardiovascular disease and risk factors prior 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 associated with persistence in continuing medication regimens.

Bushnell also explained that many times, patients aren't discontinuing their medications on their own, but rather their doctors may be discontinuing them.

"I think that a lot of patients will tell their doctors that the medication 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. "Many doctors try to limit the number of medications a patient has to take, especially 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 medication 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 medication 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' medication compliance through better communication and by being aware of the factors associated with medication discontinuation."

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

This study was conceived and designed by the AVAIL team, researchers at Duke Clinical Research Institute, the project executive committee and an American Heart Association representative. The AVAIL analyses were also supported in part by a grant from the Agency for Healthcare Research and Quality.

Media Contacts: Jessica Guenzel, jguenzel@wfubmc.edu, (336) 716-3487; Bonnie Davis, bdavis@wfubmc.edu, (336) 716-4977; or Main Number (336) 716-4587.

Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of Wake Forest University Health Sciences, which operates the university's School of Medicine, Wake Forest University Physicians and North Carolina Baptist Hospital. U.S. News & World Report ranks the School of Medicine among the nation's best medical and osteopathic schools: 33rd in primary care, 44th in research, 23rd for its physician assistant program, and 11th for its joint program with the UNC-Greensboro to train nurse anesthetists. Best Doctors in America includes 214 of the Wake Forest medical school faculty. The institution is in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property. The Medical Center has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993.

Jessica Guenzel | EurekAlert!
Further information:
http://www.wfubmc.edu

More articles from Studies and Analyses:

nachricht Physics of bubbles could explain language patterns
25.07.2017 | University of Portsmouth

nachricht Obstructing the ‘inner eye’
07.07.2017 | Friedrich-Schiller-Universität Jena

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Physicists Design Ultrafocused Pulses

Physicists working with researcher Oriol Romero-Isart devised a new simple scheme to theoretically generate arbitrarily short and focused electromagnetic fields. This new tool could be used for precise sensing and in microscopy.

Microwaves, heat radiation, light and X-radiation are examples for electromagnetic waves. Many applications require to focus the electromagnetic fields to...

Im Focus: Carbon Nanotubes Turn Electrical Current into Light-emitting Quasi-particles

Strong light-matter coupling in these semiconducting tubes may hold the key to electrically pumped lasers

Light-matter quasi-particles can be generated electrically in semiconducting carbon nanotubes. Material scientists and physicists from Heidelberg University...

Im Focus: Flexible proximity sensor creates smart surfaces

Fraunhofer IPA has developed a proximity sensor made from silicone and carbon nanotubes (CNT) which detects objects and determines their position. The materials and printing process used mean that the sensor is extremely flexible, economical and can be used for large surfaces. Industry and research partners can use and further develop this innovation straight away.

At first glance, the proximity sensor appears to be nothing special: a thin, elastic layer of silicone onto which black square surfaces are printed, but these...

Im Focus: 3-D scanning with water

3-D shape acquisition using water displacement as the shape sensor for the reconstruction of complex objects

A global team of computer scientists and engineers have developed an innovative technique that more completely reconstructs challenging 3D objects. An ancient...

Im Focus: Manipulating Electron Spins Without Loss of Information

Physicists have developed a new technique that uses electrical voltages to control the electron spin on a chip. The newly-developed method provides protection from spin decay, meaning that the contained information can be maintained and transmitted over comparatively large distances, as has been demonstrated by a team from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute. The results have been published in Physical Review X.

For several years, researchers have been trying to use the spin of an electron to store and transmit information. The spin of each electron is always coupled...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

 
Latest News

Programming cells with computer-like logic

27.07.2017 | Life Sciences

Identified the component that allows a lethal bacteria to spread resistance to antibiotics

27.07.2017 | Life Sciences

Malaria Already Endemic in the Mediterranean by the Roman Period

27.07.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>