Prevalence of Nonadherence One Year Prior to Stroke

Objective: Estimate the prevalence of nonadherence to anti-hypertensive treatment in the year prior to patients’ admission to a Stroke Unit between October 2022 and October 2023. Design and method: We conducted a retrospective non-blinded analysis. Data of hypertensive patients admitted in a level B Stroke Unit from October 1st 2022 to October 31st 2023 due to ischemic stroke, hemorrhagic stroke or transient ischemic attack (TIA) was collected. Patients deceased before November 2023 were excluded due to data unavailability. At the admission moment (by local protocol) all patients were questioned if they took their medication daily, those records were also collected. We analysed data from the national prescription software platform and obtained the purchases from the prior 18 months to ensure enough pill acquisition for the year previous to the event. Descriptive analysis was performed using SPSS Statistics 23® Results: One-hundred-and-forty-five patients were included, 111 for ischemic stroke, 24 for hemorrhagic stroke and 10 for TIA. Forty-seven patients were excluded due to death (n=20), absence of medication/new diagnosis (n=27) or missing data (n=2). Seventy-eight were male (52.4%), the mean age was 76.1 years (±27.2) and 53.1% (n=77) had 3 or more modifiable cardiovascular risk factors. Sixty-nine were treated with only one anti-hypertensive drug and 13 with 3 or more drugs. Only 8 were treated with poly-pill combinations, the majority of the drugs were prescribed to be taken daily (n=135) and the number of pills per package ranged from 28 to 60 pills. Only 27 bought enough anti-hypertensive medication for 365 days. Ninety-four (64.8%) bought for less than 300 days and 75 (51.7%) for less than 250 days. Only 11.7% (n=17) assumed nonadherence at hospital admission. Conclusions: Adherence is hard to evaluate in real-world experience. The purchase of anti-hypertensive drugs does not confirm adherence, however, we consider it is highly unlikely that the patients who purchase drugs for less than 250 days for a year were adherent to therapy.