Sang Won Han and Cheryl D Bushnell
Purpose: In stroke patients, a group at high risk for readmission, there is limited information on medication persistence and its impact on readmission. Utilizing data from a quality improvement program for post-acute processes of care, we investigated the relationship between secondary prevention medication persistence and risk for 90-day readmission in acute stroke patients.
Methods: Patients were eligible for the study if they were age 18 years or older and hospitalized with a primary diagnosis of acute ischemic or hemorrhagic stroke, or transient ischemic attack (TIA). A total of 142 patients who had been enrolled in the Transition Coaching for Stroke (TRACS) program were included in the analysis.
Results: The mean age was 63.6 ± 13.13 years and 52.8% were women. History of a prior stroke was significantly associated with medication non-persistence (p=0.013, odds ratio [OR], 4.85; 95% confidence interval [CI] 1.39-16.96). History of a prior stroke was also significantly associated with readmission for recurrent stroke or TIA within 30 days of discharge (p= 0.029, OR 7.00; 95% CI 1.22-40.23). Logistic regression modeling with stroke/TIA readmission at 90 days showed that only prior stroke was significant (p= 0.012, OR 5.54; 95% CI 1.45-21.10). A trend toward lower medication persistence was observed in patients readmitted with a stroke/TIA within 90 days (60.0% vs. 81.8%, p=0.095).
Conclusions: In patients discharged with stroke, history of a prior stroke was significantly associated with stroke/TIA readmission at 30 and 90 days after discharge. Poor secondary prevention medication persistence may be a potential risk factor for stroke/TIA readmission. Quality improvement programs focused on improving medication persistence may be essential, especially in patients with a history of recurrent strokes.