ArticlePatient preference and adherence2026
Postdischarge Class-Complete Secondary Prevention Medication Nonadherence After Ischemic Stroke: Overall and Comorbidity-Specific Patterns.
Article in Patient preference and adherence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study aimed to evaluate postdischarge class-complete secondary prevention medication nonadherence after ischemic stroke and identify overall and comorbidity-specific factors associated with 180-day nonadherence. Methods: We conducted a retrospective cohort study using prospectively collected follow-up data from a stroke registry, including consecutive patients hospitalized with acute ischemic stroke. Medication use was assessed at discharge, 90 days, and 180 days after discharge. Class-complete discontinuation-that is, discontinuation of at least one of the secondary prevention medication classes prescribed at discharge, including antiplatelet agents, anticoagulants, lipid-lowering medications, antihypertensive medications, and glucose-lowering medications-was the primary outcome. Any-use adherence, defined as continued use of at least one secondary prevention medication class, was used for comparison. Multivariable logistic regression was performed to identify factors associated with 180-day class-complete nonadherence, with subgroup analyses among patients with hypertension and diabetes mellitus. Results: A total of 2549 patients with ischemic stroke were included. At 180 days, 1408 patients (55.2%) had discontinued at least one prescribed secondary prevention medication class, whereas only 738 (29.0%) had discontinued all prescribed classes; 1141 (44.8%) continued every class prescribed at discharge. Class-complete adherence declined from 59.4% at 90 days to 44.8% at 180 days, whereas any-use adherence was 85.9% and 71.0%, respectively. Each additional discharge medication class was associated with higher odds of 180-day class-complete nonadherence in a prespecified multivariable model (adjusted odds ratio [OR], 1.50; 95% CI, 1.27-1.79). Cardioembolism (OR, 2.11; 95% CI, 1.37-3.26), dyslipidemia (OR, 1.50; 95% CI, 1.09-2.07), and large-artery atherosclerosis (OR, 1.24; 95% CI, 1.03-1.49) were also associated with nonadherence; hypertension was of borderline significance (OR, 1.23; 95% CI, 0.99-1.54; P = 0.067). In subgroup analyses, the association with number of discharge medication classes was similar across the hypertension and diabetes mellitus subgroups, with no evidence of effect modification (P for interaction = 0.32 and 0.67), whereas the association with large-artery atherosclerosis was stronger among patients with hypertension (OR, 1.37; 95% CI, 1.08-1.73) or diabetes mellitus (OR, 1.43; 95% CI, 1.10-1.87) than among those without (P for interaction = 0.036 and 0.009, respectively). Conclusion: Class-complete medication nonadherence was common within 180 days after ischemic stroke discharge and often reflected partial discontinuation rather than complete cessation of secondary prevention therapy. Medication-class-specific follow-up may help identify incomplete regimen continuation and guide targeted support for patients with greater treatment complexity, atherosclerotic stroke mechanisms, or chronic vascular comorbidities.
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