Why Stroke Patients Stop Taking Medication

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If you know someone who had a stroke recently, chances are one in four he or she will stop taking one or more of their prescribed stroke medications within the first three months of hospitalization. Why do some stroke patients stop taking their medication at a time they are most vulnerable to another stroke?

Stroke in the United States

An estimate 6.4 million people in the United States have had a stroke, according to the American Heart Association’s “Heart Disease and Stroke Statistics, 2010 Update At-a-Glance.” Each year, about 795,000 people experience a new or recurrent stroke: about 610,000 are first occurrences, and 185,000 are recurrent. About 55,000 more women than men have a stroke each year.

New Stroke Study
Researchers at Wake Forest University Baptist Medical Center evaluated 2,598 patients from the Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) Registry to determine how many of the stroke patients continued to take their prescribed medications during the first three months post-hospitalization. This three-month time period is when the risk of having a second stroke is the greatest, so it is critical for patients to take their medications to prevent a recurrence.

Cheryl D. Bushnell, MD, MHS, associate professor of neurology at Wake Forest and lead author on the study noted that “Physicians can prescribe all of the right medications, but if patients don’t take them, they’re not receiving the benefits of prevention.” To help determine why some patients don’t take their medications, the study was designed to examine compliance issues from the patients’ perspective, and also included provider and medical system issues.

The researchers found that about 75 percent of patients continued to take all their prescribed medications, which typically included a blood thinner, blood pressure medication, and cholesterol lowering medication. Nearly 20 percent of patients had stopped taking one or more of the doctor-ordered medications, and 3.5 percent had stopped taking all their drugs at three months.

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Bushnell noted that “It’s surprising at how high the compliance rate was,” although the percentage of patients who stop taking some or all of their medications is still a big concern. The researchers found that patients who continue taking their drugs often have insurance, a better quality of life, fewer financial hardships, are prescribed fewer drugs, and have cardiovascular disease and are motivated to try to prevent a second stroke.

Why do some patients stop taking their medication? “I think that a lot of patients will tell their doctors that the medication doesn’t agree with them or they can’t take it for some other reason and the doctor takes them off of it,” Bushnell explained. Some patients may feel overwhelmed by the stroke and having to take a lot of medications, so they stop one or more of the drugs.

Bushnell and her colleagues learned, however, that when patients understand why they are being prescribed certain medications and how they can refill their prescriptions, they are more likely to be compliant. She sees this as an important opportunity to teach patients about their drugs.

“We, as doctors, need to make sure we are giving patients more specific information upon discharge,” she noted. Bushnell said this study has changed how she interacts with her patients. “I’ve started asking the sometimes uncomfortable questions about whether they can afford their medications and if they’re taking them. If they aren’t, I’m asking why.”

Patients who have had a stroke can reduce their risk of experiencing another stroke if they take their prescribed medication. Doctors can play a significant role in helping stroke patients understand what they need to take and why, which can increase patient compliance and thus reduce the number of recurrent strokes.

SOURCES:
American Heart Association
Wake Forest University Baptist Medical Center

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