25% of stroke patients take medication inconsistently

When prescribing medication for stroke patients, physicians may need to clarify why the medicine is necessary and how to obtain refills, the author of a new study says. Attention should be paid to patients who are unaccustomed to taking multiple drugs, because they have a higher rate of noncompliance than their counterparts.

In an Archives of Neurology study published online Aug. 9, researchers found that one in four stroke patients discontinues medicine prescribed to prevent a recurrent stroke within three months of hospitalization. Chances of having another stroke are highest during those three months, according to the study's authors.

Stroke is the third-leading cause of death in the U.S., behind heart disease and cancer, according to the Centers for Disease Control and Prevention. About 137,000 people died of a stroke in 2006, according to the most recent CDC data. Each year, about 180,000 people who survive a stroke have another one.

"We can prescribe medications all day long, but if patients don't take them, they're not getting the benefits of [secondary] stroke prevention," said lead study author Cheryl Bushnell, MD, associate professor of neurology at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

For the study, researchers examined data on 2,598 patients 18 and older who were admitted to 106 U.S. hospitals with acute ischemic stroke or transient ischemic attack between July 2006 and September 2008.

Participants were asked standardized questions about their medication use three months after they were discharged from a hospital. Of those who were prescribed medication, 75.5% were still taking all of their drugs, 21% were taking some of their drugs and 3.5% were no longer using their medication (link).

The majority of discontinuation was due to physicians taking patients off medication for unknown reasons. But across all drug classes, a small number of patients chose to stop following treatment. The study found that 1.5% stopped taking warfarin, and 4.3% went off diuretics.

People who chose to stop at least one medication tended to be younger, were prescribed more medicine at discharge and had fewer risk factors for cardiovascular disease than patients who followed physicians' orders.

"This is the population we need to provide support for and reinforce that they need to stay on these medications," Dr. Bushnell said.