Medication Persistence Rates and Factors Associated with Persistence in Patients Following Stroke: A Cohort Study

Background: Medication nonadherence can be as high as 50% and results in suboptimal patientoutcomes. Stroke patients in particular can benefit from pharmacotherapy for thrombosis, hypertension,and dyslipidemia but are at high risk for medication nonpersistence.Methods: Patients who were admitted to the Queen Elizabeth II Health Sciences Centre in Halifax, NovaScotia, with stroke between January 1, 2001 and December 31, 2002 were analyzed. Data collected werepre-stroke function, stroke subtype, stroke severity, patient outcomes, and medication use at discharge,and six and 12 months post discharge. Medication persistence at six and 12 months and the factorsassociated with nonpersistence at six months were examined using multivariable stepwise logisticregression.Results: At discharge, 420 patients (mean age 68.2 years, 55.7% male) were prescribed an average of 6.4medications and mean prescription drug cost was $167 monthly. Antihypertensive (91%) andantithrombotic (96%) drug use at discharge were frequent, antilipidemic (73%) and antihyperglycemic(25%) drug use were less common. Self-reported persistence at six and 12 months after stroke was high(> 90%) for all categories.In the multivariable model of medication nonpersistence at six months, people aged 65 to 79 years wereless likely to be nonpersistent with antihypertensive medications than people aged 80 years or more (Oddsratio (OR) 0.11, 95% Confidence Interval (CI) 0.03–0.39). Monthly drug costs of < $90 or $90–199.99were associated with greater nonpersistence, compared to monthly drug costs ≥$200 (OR 6.74, 95% CI1.32–34.46 for < $90; OR 5.25, 95% CI 1.14–24.25 for $90–199.99). For the antithrombotic drug category,people aged 65 to 79 years were less likely to be nonpersistent than people aged 80 years or more (OR0.23, 95% CI 0.06–0.81), and people who were disabled before admission were more likely to benonpersistent than those not disabled (OR 7.01, 95% CI 1.66–29.58).Conclusion: Patients reported high medication persistence rates six and 12 months after stroke.Identification of factors associated with nonpersistence (such as older age and prior disability) will helppredict which patients are at higher risk for discontinuing their medications.