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 The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

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: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

Im Focus: Fast, convenient & standardized: New lab innovation for automated tissue engineering & drug

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.

MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...

Im Focus: Silencing bacteria

HZI researchers pave the way for new agents that render hospital pathogens mute

Pathogenic bacteria are becoming resistant to common antibiotics to an ever increasing degree. One of the most difficult germs is Pseudomonas aeruginosa, a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Molecular Force Sensors

20.09.2017 | Life Sciences

Producing electricity during flight

20.09.2017 | Power and Electrical Engineering

Tiny lasers from a gallery of whispers

20.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>