Adherence to secondary prevention strategies after stroke: A review of the literature

Of the 110000 annual new stroke occurrences in the UK, one third will go on to have a further stroke. Recurrent stroke is more likely to be fatal than first stroke and survivors are more likely to be left with major disability (Rothwell, 2007). Stroke recurs in up to 20% of patients, most commonly within the first year, and within the first 90 days following a transient ischaemic attack (Feasby and Barnett, 2007; Talelli and Greenwood, 2008). However, modification of reversible risk factors can reduce morbidity and mortality and improve survival (Chaudhry and McDermott, 2008). Despite this, studies have shown that secondary risk factor management is not optimal (Qureshi et al, 2001; Tsui et al, 2004; Chaudhry and McDermott, 2008). Patient non-adherence may be one of the reasons for this and therefore a greater understanding of why the patient may not adhere to secondary prevention advice is needed. The literature surrounding adherence and strategies to improve adherence to both medication and lifestyle advice in stroke survivors will be reviewed, as well as for other important risk factors for stroke prevention.