3170 Factors associated with high adherence to secondary preventative medications 12 months after a stroke

Abstract

Introduction Prior stroke is one of the biggest risk factors for future stroke events. Secondary prevention medications are key to reducing subsequent vascular events, and guidelines recommend use of antithrombotics, antihypertensives and lipid lowering drugs. We carried out a retrospective study of adherence to these medications in a post stroke population. Methods Consecutive patients admitted with acute stroke to a Dublin hospital between July 2022 and November 2023 were invited to participate. Participant interviews were carried out at 1 year post stroke to collect demographic and clinical information and evaluate care needs. Functional ability was graded using the Modified Rankin Scale (mRS). Adherence to three key categories of secondary preventative drugs was assessed using the 4-item Morisky Medication Adherence Scale, and participants were asked to show all current medications, which were compared to the discharge prescription. Results Interviews were conducted with 197 participants 1 year post stroke. Mean age was 68.8 years and 66% were male. Ethnicity was as follows: 79% white Irish, 11% other white, 5% African, 5% Arabic/Asian/others. Twelve (6%) were living in nursing homes while 68% were functionally independent with mRS 0–2. High adherence to all prescribed medicines was reported at 79% and was higher for antihypertensives and antithrombotics (87%) than for lipid-lowering drugs (78%). There were no statistically significant differences in self-reported adherence between gender or race subgroups. Adherence was better for participants who were functionally dependent by mRS (71% vs 97%, p < 0.0001) and those who had an involved caregiver (69% vs 89%, p < 0.0001). Discussion Self-reported adherence to medication was high in this cohort but one fifth were not adherent to important secondary prevention medications 1 year after a stroke. Adherence was higher for those who had more disabling strokes and an involved caregiver. No race or gender disparities in adherence were observed in our population.