Abstract 10437: Poor Adherence to Medications and Risk-Reduction Behaviors After a Stroke or Transient Ischemic Attack in a Predominantly Inner-city Black Population: A Pilot Study
Background: Nonadherence to prescribed medications and to recommended risk-reduction behaviors (RRBs) after hospital discharge is associated with recurrent vascular events and death among patients (pts) with stroke or transient ischemic attack (TIA). However, little is known about nonadherence rates among inner-city black pts, who are disproportionately affected by stroke but less likely than whites to receive follow-up care; also unknown is the impact of pt recall of discharge information on subsequent adherence.
Methods: To obtain preliminary data, we conducted a prospective pilot study of 50 pts (80% stroke, 20% TIA; age 63±11 yrs; 52% male, 92% black) in a large urban medical center. Recall of indications for stroke-related discharge medications (antithrombotics, antihypertensives, lipid-lowering and glucose-control agents, avg. no.=4 drugs) and of RRBs at discharge (diet, exercise, smoking cessation) was assessed by structured telephone questionnaire ~2 wks after discharge (all pts); adherence was assessed ~3 mos after discharge (46 pts) via the 8-item Morisky scale (medications) and structured questionnaire (RRBs), again by telephone. The χ2 test compared adherence among study pts vs. those in the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) trial. Logistic regression with age and gender adjustment was used to test prediction of adherence.
Results: Indications for more than half of prescribed medications were not recalled by 26 pts (52%); 22 pts (44%) did not recall being given ≥1 RRB in the hospital. The rate of medication nonadherence (46%), defined as failure to take ≥1 class of medication for reasons other than provider recommendation, was 3.5 times greater compared to AVAIL pts (13%, p<0.0001); 15 pts (30%) reported not following ≥1 RRB. Recall of indications for prescribed medications and of RRBs predicted subsequent adherence (medications, p=0.007, OR=6.8, 95% CI=1.9 to 24.2; RRBs, p=0.002, OR=10.6, 95% CI=2.7 to 41.9)
Conclusions: Nonadherence to hospital discharge instructions after stroke is highly prevalent among inner-city blacks. Lack of recall of medication indications and RRBs prescribed at discharge negatively impacts adherence in this high-risk population and represents a target for intervention.
- © 2013 by American Heart Association, Inc.