Factors associated with medication persistence among ischemic stroke patients: a systematic review

ABSTRACT

Objective

An investigation of the prevalence of medication persistence and associated factors in order to inform effective strategies for improving medication persistence.

Methods

A systematic review of the literature from 2010 to the present was performed, using the PRISMA protocol. Primary and empirical observational studies of adult ischemic stroke or transient ischemic attack patients were included. PubMed, CINAHL, Web of Science, Cochrane Library, and PsycInfo databases were searched using the key terms stroke, ischemic stroke, medication persistence, medication adherence, and patient compliance.

Results

Of four hundred twenty-eight journal articles retrieved, a final 18 articles were included. Short-term medication persistence was 46.2–96.7%, and long-term medication persistence was 41.7–93.0%. Identified hospital-related factors for medication persistence were stroke unit care, in-hospital medical complications, and early follow-up visit. Demographic factors for medication persistence were older age, and high/adequate financial status; disease-related factors were disease history, stroke subtype, and symptom severity. Age less than 75, female sex, comorbidity, antiplatelet medication switch, and polypharmacy were identified as factors of medication nonpersistence.

Conclusions

Stroke patients’ medication persistence decreases over time, and persistence on antiplatelets, anticoagulants, and statin was poor. Several factors were associated with medication persistence, and these factors should be considered in future secondary preventative strategies.

KEYWORDS:

• Ischemic stroke
• transient ischemic attack
• self-management
• medication persistence
• predictors

Acknowledgments

Editorial support with manuscript development was provided by the Cain Center for Nursing Research and the Center for Transdisciplinary Collaborative Research in Self-Management Science (P30, NR015335) at The University of Texas at Austin School of Nursing.

Disclosure statement

The authors declare no potential conflicts of interest with respect to this research, authorship, and/or publication of this article.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes on contributors

Dong Eun Jang

Dong Eun Jang, RN, MSN, is a doctoral student at University of Texas at Austin, School of Nursing. Her current research interests involve improving self-management in stroke patients.

Julie Ann Zuñiga

Julie Ann Zuñiga, RN, PhD, FAAN, is an assistant professor at University of Texas at Austin School of Nursing. Her current research is self-management of multiple morbidities.