Introduction: Proper adherence to medication regimens including antihypertensive, antidiabetic, and lipid-lowering medications has been shown to reduce risk of stroke-related events. Yet stroke and TIA survivors have suboptimal levels of adherence. Few studies have investigated how medication adherence differs between patients with previous stroke/TIA history compared to patients admitted for a first stroke event.
Methods: The present analysis examined baseline data from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study, an RCT of a skills-based educational intervention in a multi-ethnic cohort of stroke/TIA patients (n=458). The primary outcome measure was medication adherence, which was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Medication adherence was calculated and categorized as low adherence (score<6; 39%) and medium/high adherence (score 6-8; 61%). The exposure was previous stroke/TIA events, and was categorized as no previous stroke/TIA events (67%) and at least one previous stroke/TIA event (33%). Unadjusted and adjusted logistic regression models were used to investigate the relationship between previous stroke/TIA events and medication adherence. The multivariable model adjusted for relevant clinical and socio-demographic characteristics.
Results: The unadjusted logistic regression model assessing the relationship between previous stroke/TIA and medication adherence was not significant (OR: 0.70 , p=0.08, 95% CI: 0.47-1.05). But, after adjusting for select clinical and socio-demographic characteristics the model showed that patients with a history of previous stroke/TIA events were significantly less likely to have medium/high medication adherence compared to patients admitted for a first stroke event (OR: 0.59 , p=0.02, 95% CI: 0.38-0.93).
Conclusions: As part of continued preventive efforts, educational interventions such as DESERVE are necessary after a first stroke/TIA to improve medication adherence and reduce risk of future stroke/TIA events.