Long‐Term Secondary Preventive Medication Persistence and Adherence in Young Ischemic Stroke Survivors: A Prospective Single‐Center Cohort Study

TL;DR

This study found that most young stroke survivors continue their medications long-term, but adherence varies based on age, stroke cause, and quality of life.

Contribution

The study provides insights into long-term medication adherence and persistence in young ischemic stroke survivors and identifies key influencing factors.

Findings

80.1% of patients remained persistent with their medication regimen over 3.9 years.

Older age and large artery atherosclerosis were independent predictors of better adherence.

Poor adherence was linked to younger age, absence of atherosclerosis, and lower quality of life.

Abstract

The study aimed to evaluate long‐term medication persistence and adherence to secondary prevention therapies in young ischemic stroke survivors (aged 18–49 years) and identify factors influencing these outcomes.

The single‐center prospective cohort study enrolled young ischemic stroke patients (aged 18–49 years) from March 2017 to March 2023. Medication persistence (continuation of all prescribed secondary prevention drugs) and adherence (assessed by the Morisky Medication Adherence Scale‐8 (MMAS‐8)) were evaluated, with reasons for discontinuation and influencing factors analyzed.

Among 226 patients (median age 35 years, 34.5% female), 80.1% remained persistent with their medication regimen over a median follow‐up of 3.9 years. Patients with persistence had higher rates of large artery atherosclerosis (42% vs. 22.2%, p = 0.015) and comorbid diabetes (13.3% vs. 2.2%, p = 0.015). The median MMAS‐8 score was 7 (6–7.38), with 24.2% showing high adherence, 63% moderate adherence, and 12.8% poor adherence. Poor adherence was associated with younger age (<35 years, p = 0.018), the absence of large artery atherosclerosis (p = 0.017), and a lower quality of life (p = 0.004). Multivariate analysis revealed that older age (p = 0.043) and large artery atherosclerosis (p = 0.047) were independent predictors of better adherence.

Young ischemic stroke patients demonstrated high medication persistence and moderate adherence, which were influenced by age, stroke etiology, and quality of life. These findings highlight the need for tailored secondary prevention strategies to improve outcomes in this population.

In a prospective cohort of 226 young ischemic stroke survivors, medication persistence was high (80.1%) over a median 3.9‐year follow‐up, while adherence was moderate. Older age and large artery atherosclerosis predicted better adherence, whereas younger age and lower quality of life were associated with poor adherence.

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