Several Barriers Promote Non-Adherence to Statins Among Stroke Survivors

One-third of strokes worldwide occur in stroke survivors.

Although stroke survivors are at risk of a second stroke that carries a greater risk of disability and death, adherence to secondary preventive medications is low, with 30% of patients failing to take their medications as prescribed.

In a study published in BMJ Open, investigators sought to examine the barriers to medication adherence among stroke survivors. They analyzed posts in a UK-based online forum called TalkStroke between 2004 and 2011.

TalkStroke is hosted by the Stroke Association and is used by stroke survivors and their caregivers. It was previously used by the investigators to examine issues such as impairment and the impact on holding jobs.

The investigators examined posts from 84 participants, including 49 stroke survivors and 33 caregivers. The results of the analysis revealed that adverse events (AEs) were a major factor in reasons for stopping medications, with several users reporting negative AEs that led to non-adherence.

Other forum users, either stroke survivors or caregivers, reported discontinuing treatment after reading stories in the media about negative AEs, especially regarding statins.

Statins are prescribed to help lower cholesterol levels in the blood to help prevent heart attacks and stroke.

Other issues included concerns over the medication the patients were offered. Some users expressed conflicting views about the medication’s efficacy, with some believing they were important and others feeling the risks could be managed through lifestyle changes.

There were also mixed reports on health care professions. Some contributors felt confident in their physician’s decision and others questioned their decisions. According to the report, some users even questioned their physician’s motivation for prescribing particular drugs.

“These findings have highlighted the need for an open, honest dialogue between patients and/or their carers, and health care professions,” Dr De Simoni said. “Doctors need to listen to these concerns, discuss the benefits and drawbacks of taking the medication, and be willing to support a patient’s informed decision to refuse medications.”

Practical considerations were also found to be barriers to adherence. At times, medications were too large, making it difficult to swallow or the treatment regimen was too burdensome, according to the study.

“By analyzing people’s views as expressed in online forums, where they are more open and less guarded, we’ve seen some valuable insights into why some stroke survivors have difficulty adhering to their medication,” said first author James Jamison, Department of Public Health and Primary Care at Cambridge. “Challenging negative believes about medication and adopting practices that make routines for taking medication simpler, particularly for those patients who have suffered disability as a result of stroke, should increase adherence and ultimately improve health outcomes.”