title: Drug compliance after stroke and myocardial infarction: a comparative study.
abstract: BACKGROUND
  Stroke and myocardial infarction (MI) are both life-threatening diseases of vascular origin with a tendency to recur. In both conditions, risk of recurrence is reduced through similar drug regimens.
  
  
  OBJECTIVE
  To determine if compliance with prescribed medication after stroke or MI was similar in the two populations.
  
  
  METHODS
  Retrospective data collection and cross-sectional telephonic survey of patients discharged from a single academic medical center.
  
  
  METHODS
  Adult patients consecutively discharged over a two-year period with a diagnosis of first-ever stroke (ischemic or hemorrhagic) or first-ever MI (ST-elevation) were identified through ICD-9 codes. Clinical details were abstracted from hospital records. Medication compliance was assessed through a structured telephone interview.
  
  
  METHODS
  Bivariate analysis using Chi-square and Fisher exact tests, to determine the prevalence of noncompliance in stroke versus MI patients and differences in baseline characteristics and multivariate analysis with logistic regression to determine independent predictors of noncompliance.
  
  
  RESULTS
  Follow-up data was collected for 298 stroke and 275 MI patients. Compliance was lower in stroke patients (68% stroke patients compliant with at least half their discharge prescriptions versus 90% MI patients; P < 0.001). Literacy and post-discharge follow-up were associated with greater compliance (P < 0.05 for both). Compliance was highest with anti-hypertensive drugs (98% after MI, 78% after stroke), followed by anti-platelet agents (94% after MI, 75% after stroke) and anti-lipid agents (70% after MI, 59% after stroke). Patients reported simply not feeling the need, acquiring fresh medical advice or a perceived lack of benefit, as reasons for not complying with their discharge prescriptions.
  
  
  CONCLUSIONS
  Although similar drugs are involved, compliance with prescribed regimens is appreciably lower after stroke than after MI. Our findings underscore the need for better patient education regarding secondary prevention after stroke.
authors.affiliation: Department of Neurology, Aga Khan University Medical College, Karachi, Pakistan.
authors.forename: Hiba
authors.initials: H
authors.lastname: Arif
authors.forename: Bilal
authors.initials: B
authors.lastname: Aijaz
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.forename: Unber
authors.initials: U
authors.lastname: Aftab
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.forename: Saad
authors.initials: S
authors.lastname: Shafqat
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000523:psychology; D010349:Patient Compliance; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000523:psychology