MANAGED CARE February 2010. ©MediMedia USA
Only half to three-fourths of stroke survivors who had been discharged from the hospital were still using preventive medication two years later, according to a large Swedish study published in Stroke: Journal of the American Heart Association. This disconcerting finding can be seen as an opportunity that health plans can take advantage of by providing clinical support and patient education to providers and members. Preventing a second stroke by improving adherence to a medication regimen becomes all the more important.
“To prevent new cardiovascular events after stroke, preventive drugs should be used continuously,” says Eva-Lotta Glader, MD, PhD, lead investigator. “Yet the proportion of patients who were persistent users of drugs prescribed at discharge from hospital declined steadily over the first two years.”
After two years, only 74.2 percent of patients were still taking antihypertensive drugs, 56.1 percent were still taking statins, 63.7 percent were still taking antiplatelet drugs, and 45 percent were still taking warfarin. Glader points out the rapid declines for statins and warfarin and says that effective interventions need to be developed to improve persistent secondary prevention after stroke.
The recommendations to take preventive medications after a stroke are very similar here in the United States, says Bruce Ovbiagele, MD, associate professor of neurology and director of the stroke prevention program at UCLA.
“These medications are recommended to be taken indefinitely” after a patient has had a stroke, says Ovbiagele.
“I suspect if you tried to conduct this type of study nationally in this country, first, you’d have a lot of difficulty, and second, you’d find the drop-off even more drastic and much earlier,” says Ovbiagele.
Ovbiagele points out that in the study, patients who were discharged from the hospital and who subsequently received institutional care were more likely to continue taking their stroke prevention medications. Managed care might benefit from the findings by “having a system in place to make sure patients remain on their medication. I think patients need some system in place to remind or prompt them to continue taking their medications.”