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 Real-time feedback helps save energy and water
08.02.2017 | Otto-Friedrich-Universität Bamberg

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

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: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Stingless bees have their nests protected by soldiers

24.02.2017 | Life Sciences

New risk factors for anxiety disorders

24.02.2017 | Life Sciences

MWC 2017: 5G Capital Berlin

24.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>