Advancements and challenges of adherence to secondary prevention medications among patients with ischemic stroke or transient ischemic attack: the healthcare quality improvement in China, 2007–2018

Abstract

Background: Despite significant achievements in healthcare quality improvement for ischemic stroke and transient ischemic attack (TIA), the advancements and challenges of patient adherence to secondary prevention medications remain unclear. Objectives: We aimed to investigate adherence rates of secondary prevention medication and identified the key determinants in Chinese patients with ischemic stroke or TIA. Design: This is an observational study. Methods: Using the China National Stroke Registry (CNSR) database from 2007 to 2018, this observational study included patients with ischemic stroke or TIA who were admitted to the hospital within 7 days of symptom onset. The study outcome was the patient adherence to secondary prevention medications, which was defined as the consistent use of prescribed antithrombotic, lipid-modulating, antidiabetic, and antihypertensive medications post-discharge using an “all-or-none” approach. We calculated adherence rates in 3 and 12 months. Logistic regression models were used to evaluate influencing factor patterns and challenges in the improvement of patient adherence. Results: A total of 12,873 patients from CNSR I and 15,099 patients from CNSR III were included. Patient adherence rates for secondary prevention medications increased from 66.97% in CNSR I to 80.76% in CNSR III (p < 0.0001) in 3 months, and from 35.08% to 59.81% (p < 0.0001) in 12 months. Patient age, the National Institute of Health stroke scale score at admission, disease diagnosis, the Trial of Org 10172 in Acute Stroke Treatment classification, family income per capita, alcohol consumption, dyslipidemia history, hypertension history, diabetes history, and heart disease history appeared to exhibit a significant association with adherence. Conclusion: In spite of the remarkable progress in patient adherence to secondary prevention of stroke from 2007 to 2018, challenges remain in sustaining quality improvement initiatives, necessitating further improvements by addressing disease severity, lifestyle, medical history, and socioeconomic factors.