Waimei Tai, MD

Thrift AG, Kim J, Douzmanian V, Gall SL, Arabshahi S, Loh M, et al. Discharge Is a Critical Time to Influence 10-Year Use of Secondary Prevention Therapies for Stroke. Stroke. 2013

Thrift et. al did an interesting analysis of discharge prescription of appropriate secondary intervention drugs (statin, blood pressure reduction agents, and antithrombotics) to persistent use at annual intervals up to 10 years out post-stroke. They used a large registry of stroke survivors from the North East Melbourne Stroke Incidence Study and followed the patients out for up to 10 years.  The odds ratio of medication persistence was 32 at two years (meaning that if patients were prescribed the medications at discharge- they were 32 times more likely to still be taking them at 2 years post stroke). The strength of the association from discharge medication prescription to subsequent medication use declined as the years progressed.

One of the strengths of the study is also its weakness. It has long term follow up with stroke survivors- and certainly in the last 10+ years, evidence for stroke prevention has changed, and thus, increases in blood pressure and statin prescribing maybe reflective more of changing practice patterns due to the evidence base for these medications increasing, rather than the acute discharge prescription patterns as being studied. The authors acknowledge this, and nonetheless, even for patients who

Providers currently working at primary or comprehensive stroke centers know that it’s a regulatory requirement to optimize discharge medication prescriptions. I think there’s a good evidence base to suggest this and this study bolsters the evidence base to do appropriate medication prescribing at time of discharge to improve not only short term, but long term medication persistence as well.

We know these simple generic medications work. Now we just have to get our patients to take them. What else can we do to improve medication persistence and adherence in the long run?