Impacts of medication non-adherence to major modifiable stroke-related diseases on stroke prevention and mortality: a meta-analysis

Abstract

Background Medication adherence is one of the crucial attempts in primary stroke prevention. The available evidence lacks comprehensive reviews exploring the association of medication adherence with stroke prevention. Objectives To investigate the effects of non-adherence to medications used to treat the modifiable risk of diseases on stroke-associated outcomes in primary stroke prevention. Methods Study records were searched from PubMed, Embase, and CINAHL. Those studies reported risks relevant to stroke-associated outcomes and medication non-adherence for patients diagnosed with four modifiable stroke-related diseases (atrial fibrillation [AF], hyperlipidemia, hypertension, and type 2 diabetes mellitus) but without stroke history were included for meta-analysis and further subgroup, sensitivity, and publication bias analyses. A random effect model was performed to analyse the pooled risk estimates of relative risk (RR) and 95% confidence intervals (CIs). Results Thirty-nine studies (with 2,117,789 participants in total) designed as cohort or case–control studies were included. Those patients presenting with four stroke-related diseases and categorised as medication non-adherent tended to result in stroke and/or associated death (all pooled RR ≥ 1 and 95% CI did not include 1). The findings of stratification and sensitivity analysis for each stroke-related disease showed a similar trend. Non-adherent patients with AF were prone to stroke occurrence (RR 1.852; 95% CI 1.583–2.166) but inclined to reduced bleeding (RR 0.894; 95% CI 0.803–0.996). The existence of publication bias warrants further interpretation. Conclusions Non-adherence to medications for the four stroke-related diseases contributes to the development of stroke and/or mortality in primary stroke prevention. More efforts are needed to improve patients’ medication adherence.

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

“…Open access significantly increases the risk of stroke and/or associated death. 3 Moreover, incomplete adherence to antihypertensive pharmacological treatment is associated with an increased risk of cardiovascular events and chronic kidney disease; indeed, a large part of resistant hypertension is the so-called pseudoresistant hypertension, due to poor or lacking MA. 4 5 Low and non-adherence also have an economic impact, both in terms of increased healthcare expenditure and more frequent sick leaves.…”

“…This is known to occur with all the most widespread chronic diseases. As an example, being non-adherent to treatment of modifiable stroke-related conditions like type 2 diabetes, atrial fibrillation, hyperlipidaemia and hypertension significantly increases the risk of stroke and/or associated death 3…”

Digital Pharmacotherapy Support for Medication Adherence

“…Среди потенциальных рисков нарушения режима приема ЛП выделим наиболее значимые: 1) обострение заболевания (усиление симптомов, увеличение продолжительности болезни и снижение качества жизни пациента) [24,25]; 2) недостаточная эффективность лечения [24,25]; 3) развитие нежелательных реакций вследствие превышения рекомендуемых концентраций ЛП в крови [24,25] Строгое соблюдение режима приема ЛП является важным элементом терапии многих сердечно-сосудистых заболеваний, таких как мерцательная аритмия, инсульт, сердечная недостаточность и др., позволяет предотвратить развитие острых сердечно-сосудистых событий, снизить частоту госпитализаций и преждевременной смерти и способствует достижению оптимальных клинических результатов [31,32,[34][35][36].…”

New terminology of medication adherence enabling and supporting activities: ENABLE terminology

“…As expressed in the well-known quote of Dr. C. Everett Koop, a former Surgeon General of the United States, “Drugs do not work in patients who do not take them”. Unfortunately, the more potent is the medication, the greater are losses suffered by the patients deviating from advised therapy, including the fatal consequence of fully preventable premature death ( Neto et al, 2021 ; Mafruhah et al, 2023 ). Moreover, non-adherence increases the risk of complications associated with the underlying conditions.…”