Postdischarge Class-Complete Secondary Prevention Medication Nonadherence After Ischemic Stroke: Overall and Comorbidity-Specific Patterns.

@article{li2026postdischarge,
  title = {{Postdischarge Class-Complete Secondary Prevention Medication Nonadherence After Ischemic Stroke: Overall and Comorbidity-Specific Patterns.}},
  author = {Yanfeng Li and Youli Jiang and Qingshi Zhao and Wan Ling Lee and Lili Wu and Chunhua Chen},
  journal = {Patient preference and adherence},
  year = {2026},
  month = oct,
  doi = {10.2147/ppa.s629530},
  url = {https://europepmc.org/article/MED/42903702},
  note = {CC BY-NC},
}

TY  - JOUR
TI  - Postdischarge Class-Complete Secondary Prevention Medication Nonadherence After Ischemic Stroke: Overall and Comorbidity-Specific Patterns.
AU  - Yanfeng Li
AU  - Youli Jiang
AU  - Qingshi Zhao
AU  - Wan Ling Lee
AU  - Lili Wu
AU  - Chunhua Chen
PY  - 2026
DA  - 2026/10/16
JO  - Patient preference and adherence
DO  - 10.2147/ppa.s629530
UR  - https://europepmc.org/article/MED/42903702
AB  - 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.
SN  - 1177-889X
ER  -