title: Secondary preventive medication persistence and adherence 1 year after stroke.
abstract: OBJECTIVE
  Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge.
  
  
  METHODS
  Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines-Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions.
  
  
  RESULTS
  Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence.
  
  
  CONCLUSIONS
  Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions.
authors: Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. cbushnel@wakehealth.edu
authors: C D
authors: CD
authors: Bushnell
authors: D M
authors: DM
authors: Olson
authors: X
authors: X
authors: Zhao
authors: W
authors: W
authors: Pan
authors: L O
authors: LO
authors: Zimmer
authors: L B
authors: LB
authors: Goldstein
authors: M J
authors: MJ
authors: Alberts
authors: S C
authors: SC
authors: Fagan
authors: G C
authors: GC
authors: Fonarow
authors: S C
authors: SC
authors: Johnston
authors: C
authors: C
authors: Kidwell
authors: K A
authors: KA
authors: Labresh
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authors: Ovbiagele
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authors: L
authors: Schwamm
authors: E D
authors: ED
authors: Peterson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012042:Registries; D055502:Secondary Prevention / Q000639:trends*; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*