Adverse event concerns fuel nonadherence to statins after stroke

Stroke survivors fail to take their secondary prevention medication because of their concerns about adverse effects, doctor prescribing practices and negative publicity of the side effects associated with statins, according to data ascertained from an online stroke forum.

“Severe stroke-related impairments make it difficult for survivors to participate in research. Perhaps for this reason there is little evidence available on factors affecting adherence to medications in patients with more disabling strokes (at least a third of stroke survivors),” James Jamison, PhD candidate from the department of public health and primary care at University of Cambridge, and colleagues wrote in BMJ Open. “The online forum offers users the opportunity to discuss issues around medication that may be considered sensitive and which they may be less willing to address through traditional face-to-face approaches.”

Between 2004 and 2011, researchers examined TalkStroke, a U.K.-based online forum for stroke survivors hosted by the Stroke Association, for posts about secondary prevention medications to determine the barriers associated with medication adherence in these patients and their caregivers. They identified 84 participants, including 49 stroke survivors and 33 caregivers, using keywords such as “taking medication,” “pills,” “size,” “side-effects,” “routine,” “blister,” and secondary prevention medication terms.

Analysis showed that forum participants’ perceptions that reduced their medication adherence included adverse effects, questioning doctors’ prescribing practices and negative media publicity about medication, especially statins. Some forum contributors who had experienced adverse adverse effects stopped taking their prescribed medication, occasionally after consulting with their PCP, whereas others reported stopping their medication after reading negative media coverage about adverse effects. Several users concerned about the medications prescribed to them reported feeling conflicted; some questioned their efficacy and their doctors’ decision or believed they could manage their risk for second stroke by changing their lifestyle choices. Other barriers to medication adherence included problems swallowing tablets, the burden of treatment and cost of medication. Caregivers experienced difficulties ensuring their patients’ medications were taken while still respecting their decisions to not take tablets, and struggled to advocate for their patient’s needs in a health care professional setting.

“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,” Jamison said in a press release. “Challenging negative beliefs 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.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.