Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke

Abstract

Our results suggest that women, patients aged <75 years, and patients without certain comorbid conditions may need improved assistance in secondary prevention management after an ischaemic stroke.

Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study

“…These contradictory findings are somewhat puzzling, and may be partially explained by the lower medication complexity in older adults with cognitive impairment, as observed in one previous study [ 29 ]. The care management by caregivers may also increase the treatment persistence in the very elderly with dementia [ 30 ], which is supported by the findings of recent studies that dementia was associated with the likelihoods of continuing statin therapy (aHR, 0.84; 95% CI, 0.73–0.98) and antiplatelet therapy in elderly patients after ischemic stroke [ 31 , 32 ].…”

Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke

“…The majority of included studies were retrospective (n = 4) [ 36 , 41 – 43 ] or prospective cohort studies (n = 4) [ 37 – 40 ]. One study was based on secondary analysis from the Secondary Prevention of Small Subcortical Strokes trial [ 44 ].…”

“…Five studies included a diagnosis of dementia as a measure of cognitive impairment [ 36 , 39 , 41 – 43 ], while one study each used the Montreal Cognitive Assessment (MoCA) [ 37 ], Mini Mental State Examination (MMSE) [ 40 ], Cognitive Abilities Screening Instrument (CASI) [ 44 ], or Everyday Functioning Questionnaire (EFQ) [ 38 ]. Diagnosis of dementia was based on data recorded in health insurance or patient registry databases [ 36 , 41 – 43 ], or on report by the patient, relative, or primary care physician [ 39 ].…”

“…Assessments of (non)adherence included the Medication Adherence Report Scale (MARS) (n = 2) [ 37 , 40 ], self-report either alone or in combination with pill counts (n = 3) [ 38 , 39 , 44 ], prescription records (n = 3) [ 41 – 43 ], or ongoing treatment registered in a Swedish national quality register for atrial fibrillation and oral anticoagulation (AuriculA) (n = 1) [ 36 ]. Three studies considered adherence to anticoagulant medications in stroke patients with AF [ 36 , 39 , 41 ], one study each focused on antiplatelets [ 43 ] and statins [ 42 ]. Three studies utilising self-report did not distinguish between medications [ 37 , 38 , 40 ], while one study combined pill counts of antiplatelet medications with self-reported antihypertensive medication adherence to create a composite adherence measure [ 44 ].…”

“…Evidence on the association between cognitive impairment and non-adherence was discordant; three studies found no association between medication adherence and cognitive impairment [ 40 , 41 , 44 ], three reported that cognitive impairment was associated with increased non-adherence [ 36 , 38 , 39 ] while three studies reported that cognitive impairment was associated with decreased non-adherence [ 37 , 42 , 43 ]. When all studies were pooled, there was no evidence of an association between cognitive impairment and non-adherence [OR (95% CI): 0.85 (0.66, 1.03)]; however, heterogeneity was substantial [ I 2 = 90.9%, p < .001] ( Fig 3 ).…”