Adherence to Secondary Stroke Prevention Strategies – Results from the German Stroke Data Bank

Abstract

Only very limited data are available concerning patient adherence to antithrombotic medication intended to prevent a recurrent stroke. Reduced adherence and compliance could significantly influence the effects of any stroke prevention strategies. This study from a large stroke data bank provides representative data concerning the rate of stroke victims adhering to their recommended preventive medication. During a 2-year period beginning January 1, 1998, all patients with acute stroke or TIA in 23 neurological departments with an acute stroke unit were included in the German Stroke Data Bank. Data were collected prospectively, reviewed, validated and processed in a central data management unit. Only 12 centers with a follow-up rate of 80% or higher were included in this evaluation. 3,420 patients were followed up after 3 months, and 2,640 patients were followed up one year after their stroke. After one year, 96% of all patients reported still adhere to at least one medical stroke prevention strategy. Of the patients receiving aspirin at discharge, 92.6% reported to use that medication after 3 months and 84% after one year, while 81.6 and 61.6% were the respective figures for clopidogrel, and 85.2 and 77.4% for oral anticoagulation. Most patients who changed medication switched from aspirin to clopidogrel. Under the conditions of this observational study, adherence to stroke prevention strategies is excellent. The highest adherence rate is noticed for aspirin and oral anticoagulation. After one year, very few patients stopped taking stroke preventive medication.

Persistent Use of Secondary Preventive Drugs Declines Rapidly During the First 2 Years After Stroke

“…Different definitions of persistence and different follow-up times contribute to the variations. Studies of self-reported drug use 1,2,5,7 are associated with a risk of overestimation of persistence. Cross-sectional studies, such as the recently published study based on the Swedish Prescribed Drug Register, 6 do not take into account whether medication is continuous and thus give higher estimates than studies of continuous/persistent drug use.…”

“…[1][2][3][4][5][6] Improved medication persistence would be a key target in secondary prevention strategies. In the present study, long-term medication persistence has been followed by linking RiksStroke, the Swedish Stroke Register, with the Swedish Prescribed Drug Register that covers all prescribed drugs dispensed at Swedish pharmacies.…”

Stroke Secondary Medication Persistence and Risk for Hospital Readmission within 90 Days after Discharge

“…Although early initiation of prevention strategies has shown sustained persistence and good outcomes in some stroke patients, other evidence suggests that use of these secondary prevention therapies may not persist long-term [19]. In a study of over 3,000 stroke patients, 84% are taking aspirin at one year post stroke, 77% oral anticoagulants, but only 61% who are prescribed Clopidogrel at discharge are still taking it one year later [24]. It has been also known that only 70% of patients are still taking cholesterol reducing treatment one year after stroke [25].…”

Changes in secondary pharmacological prevention of acute coronary syndromes and stroke after hospital discharge: a 6-month follow-up study of German primary care patients

“…Contrary to this, national and international studies have shown that these guidelines are not yet fully implemented in primary and secondary prevention with respect to platelet aggregation inhibitors, angiotensin-converting enzyme (ACE) inhibitors, betablockers, and statins (EUROASPIRE I and II Group 2001;Krumholz et al 1998;Welterman et al 1997) in the prevention of ACS. However, long-term secondary stroke prevention in Germany has revealed better findings, especially with regard to antithrombotic medications (Hamann et al 2003). Even though therapeutic guideline implementation has improved over the past years (Mandelzweig et al 2006;Wienbergen et al 2001), only few studies in Germany have examined whether treatment recommendations after hospital discharge were according to current guidelines and to what extent these recommendations were realised in subsequent primary care (Zeymer et al 2007).…”