Skip to main content

Advertisement

SpringerLink
Log in

Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Objectives

This study investigated the extent of, and patient-related characteristics for, non-persistence with antiplatelet therapy during follow-up in elderly patients after their first ischaemic non-cardioembolic stroke.

Methods

A database of the largest health insurance provider in the Slovak Republic was used to assemble the study cohort of 4319 patients (56.8 % were women) aged ≥65 years in whom antiplatelet therapy was initiated following a hospital-based diagnosis of stroke during the period 1 January 2010 to 31 December 2010. Patients were followed for 3 years from the date on which the first prescription of antiplatelet medication was recorded. Patients with a 6-month treatment gap without antiplatelet medication prescription were designated as non-persistent, and the Cox proportional hazards model was used to identify predictors of non-persistence.

Results

At the end of the 3-year follow-up period, 1184 (27.4 %) patients were considered non-persistent with antiplatelet medication. In 1244 (28.8 %) patients, a switch in the use of a particular antiplatelet drug was registered during this follow-up period. Female sex (hazard ratio [HR] 1.25) was associated with increased risk of non-persistence. In contrast, factors associated with lower probability of non-persistence were age ≥75 years (HR 0.72), switch in antiplatelet medication use (HR 0.76), diabetes mellitus (HR 0.81), dementia (HR 0.69) and epilepsy (HR 0.69).

Conclusions

Our results suggest that women, patients aged <75 years, and patients without certain comorbid conditions may need improved assistance in secondary prevention management after an ischaemic stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe: epidemiological update. Eur Heart J. 2013;34(39):3028–34.

    Article  PubMed  Google Scholar 

  2. Jorgensen H, Nakayama H, Reith J, Raaschou H, Olsen T. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology. 1997;48(4):891–5.

    Article  CAS  PubMed  Google Scholar 

  3. Mozaffarian D, Benjamin EJ, Go AS, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322.

    Article  PubMed  Google Scholar 

  4. Arnan MK, Burke GL, Bushnell C. Secondary prevention of stroke in the elderly: focus on drug therapy. Drugs Aging. 2014;31(10):721–30.

    Article  CAS  PubMed  Google Scholar 

  5. The European Stroke Organization (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457–507.

    Article  Google Scholar 

  6. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.

    Article  PubMed  Google Scholar 

  7. Grau AJ, Weimar C, Buggle F, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001;32(11):2559–66.

    Article  CAS  PubMed  Google Scholar 

  8. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.

    Article  PubMed  Google Scholar 

  9. Dezii CM. Persistence with drug therapy: a practical approach using administrative claims data. Manag Care. 2001;10(2):42–5.

    CAS  PubMed  Google Scholar 

  10. McKenzie SJ, McLaughlin D, Clark J, Doi SAR. The Burden of non-adherence to cardiovascular medications among the aging population in Australia: a meta-analysis. Drugs Aging. 2015;32(3):217–25.

    Article  PubMed  Google Scholar 

  11. Mukhtar O, Weinman J, Jackson SHD. Intentional non-adherence to medications by older adults. Drugs Aging. 2014;31(3):149–57.

    Article  PubMed  Google Scholar 

  12. Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burke JP, Sander S, Shah H, Zarotsky, Henk H. Impact of persistence with antiplatelet therapy on recurrent ischemic stroke and predictors of nonpersistence among ischemic stroke survivors. Curr Med Res Opin. 2010;26(5):1023–30.

    Article  CAS  PubMed  Google Scholar 

  14. Bushnell CD, Olson DM, Zhao X, et al. Secondary preventive medication persistence and adherence 1 year after stroke. Neurology. 2011;77(12):1182–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Flynn RW, MacDonald TM, Murray GD, MacWalter RS, Doney AS. Persistence, adherence and outcomes with antiplatelet regimens following cerebral infarction in the Tayside Stroke Cohort. Cerebrovasc Dis. 2012;33(2):190–7.

    Article  CAS  PubMed  Google Scholar 

  16. Glader EL, Sjölander M, Eriksson M, Lundberg M. Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke. Stroke. 2010;41(2):397–401.

    Article  PubMed  Google Scholar 

  17. Ji R, Liu G, Shen H, et al. Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population: data from China National Stroke Registry. Neurol Res. 2013;35(1):29–36.

    Article  PubMed  Google Scholar 

  18. Lummis HL, Sketris IS, Gubitz GJ, Joffres MR, Flowerdew GJ. Medication persistence rates and factors associated with persistence in patients following stroke: a cohort study. BMC Neurol. 2008;8:25.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Østergaard K, Hallas J, Bak S, Christensen R, Gaist D. Long-term use of antiplatelet drugs by stroke patients: a follow-up study based on prescription register data. Eur J Clin Pharmacol. 2012;68(12):1631–7.

    Article  PubMed  Google Scholar 

  20. Health Statistics Yearbook of the Slovak Republic 2013. Available at: http://www.nczisk.sk/en/Publications/Edition_Health_Statistics_Yearbooks/Pages/default.aspx. Accessed 12 Oct 2015.

  21. Casper ML, Nwaise IA, Croft JB, Nilasena DS. Atlas of stroke hospitalizations among medicare beneficiaries. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.

    Google Scholar 

  22. World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Geneva: World Health Organization; 1992. p. 191.

    Google Scholar 

  23. Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing. 1980;9(2):73–80.

    Article  CAS  PubMed  Google Scholar 

  24. World Health Organization Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 2015. Oslo: World Health Organization; 2014.

    Google Scholar 

  25. The secondary prevention of ischemic strokes. The guideline of the scientific society [in Slovak]. Available at: http://snes.sk/cms/wp-content/uploads/Usmernenie-odb-spol_sek_prevencia_iCMP.pdf. Accessed 25 Feb 2016.

  26. Newman SC. Biostatistical methods in epidemiology. Chichester: Wiley; 2001. p. 382.

    Google Scholar 

  27. Bushnell CD, Zimmer LO, Pan W, Adherence Evaluation After Ischemic Stroke-Longitudinal Investigators, et al. Persistence with stroke prevention medications 3 months after hospitalization. Arch Neurol. 2010;67(12):1456–63.

    Article  PubMed  Google Scholar 

  28. Erkens JA, Panneman MM, Klungel OH, van den Boom G, Prescott MF, Herings RM. Differences in antihypertensive drug persistence associated with drug class and gender: a PHARMO study. Pharmacoepidemiol Drug Saf. 2005;14(11):795–803.

    Article  PubMed  Google Scholar 

  29. White RD. Patient empowerment and optimal glycemic control. Curr Med Res Opin. 2012;28(6):979–89.

    Article  CAS  PubMed  Google Scholar 

  30. Shaya FT, El Khoury AC, Mullins CD, et al. Drug therapy persistence and stroke recurrence. Am J Manag Care. 2006;12(6):313–9.

    PubMed  Google Scholar 

  31. O’Shea MP, Teeling M, Bennett K. Regional variation in medication-taking behaviour of new users of oral anti-hyperglycaemic therapy in Ireland. Ir J Med Sci. 2015;184(2):403–10.

    Article  PubMed  Google Scholar 

  32. Helin-Salmivaara A, Lavikainen P, Ruokoniemi P, Korhonen M, Huupponen R. Persistence with statin therapy in diabetic and non-diabetic persons: a nation-wide register study in 1995–2005 in Finland. Diabetes Res Clin Pract. 2009;84(1):e9–11.

    Article  PubMed  Google Scholar 

  33. Johnston S, Janning SW, Haas GP, et al. Comparative persistence and adherence to overactive bladder medications in patients with and without diabetes. Int J Clin Pract. 2012;66(11):1042–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Institute of Pharmacology and Clinical Pharmacology, Comenius University, Sasinkova, 4, 811 08, Bratislava, Slovakia

    Martin Wawruch, Gejza Wimmer Jr, Lenka Kuzelova & Zoltan Kallay

  2. General Health Insurance Company, Bratislava, Slovakia

    Dusan Zatko

  3. Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Jan Luha

  4. 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Peter Kukumberg

  5. 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia

    Jan Murin

  6. Ministry of Health of the Slovak Republic, Bratislava, Slovakia

    Adam Hloska

  7. Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia

    Adam Hloska

  8. Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia

    Tomas Tesar

  9. Gerrards Cross, UK

    Rashmi Shah

Authors
  1. Martin Wawruch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dusan Zatko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gejza Wimmer Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Luha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lenka Kuzelova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Kukumberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Murin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Adam Hloska
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomas Tesar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Zoltan Kallay
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rashmi Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Wawruch.

Ethics declarations

Funding

This study was funded by grants from the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic (VEGA 1/0886/14 and VEGA 1/0939/14). The providers of these Grants played no role in the design, methods, data collection, analysis and interpretation of the data, preparation of the paper or the decision to submit the manuscript.

Conflict of interest

Martin Wawruch, Dusan Zatko, Gejza Wimmer Jr, Jan Luha, Lenka Kuzelova, Peter Kukumberg, Jan Murin, Adam Hloska, Tomas Tesar, Zoltan Kallay and Rashmi Shah declare that they have no conflicts of interest.

Ethical approval

Under applicable legal instruments of our country, the study did not require the approval of an Ethical Committee. The laws and rules of personal data confidentiality were fully complied with.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wawruch, M., Zatko, D., Wimmer, G. et al. Factors Influencing Non-Persistence with Antiplatelet Medications in Elderly Patients After Ischaemic Stroke. Drugs Aging 33, 365–373 (2016). https://doi.org/10.1007/s40266-016-0365-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-016-0365-2

Keywords

Search

Navigation