Identifying Barriers to Medications Adherence and Outpatient Follow-up After Transient Ischemic Attack: A Cross-sectional study
Chetna Dengri1, Muaz Ali1, Paola Oyola1, Amre Nouh2
1Cleveland Clinic Florida, 2Cleveland Clinic
Objective:
To evaluate adherence to secondary stroke prevention medications (antiplatelet and/or statin) and outpatient follow-up after TIA discharge, along with identifying barriers to noncompliance and loss to follow-up.
Background:
Adherence to secondary stroke prevention and timely outpatient follow-up is essential to reduce the risk of subsequent stroke following a TIA. However, reasons for medication noncompliance or loss of follow-up remains poorly understood.
Design/Methods:
We conducted a survey of patients discharged after TIA (April 2024–2025) evaluating compliance with antiplatelet and statin therapy, rate of outpatient follow-up, and reasons for noncompliance or loss to follow-up. Understanding of diagnosis and rationale behind medications was measured with a 3-point Likert scale. Demographic data were collected retrospectively. Logistic regression with Fisher’s exact tests identified predictors of follow-up.
Results:
Of 88 eligible patients, 66 (75%) completed the survey. Noncompliance with antiplatelet and/or statin therapy occurred in 24.2% (n=16), while 19.7% (n=13) were lost to follow-up. Reported reasons for noncompliance included belief medication was not necessary (25%), side effects without physician input (18.7%), physician-advised discontinuation (18.7%), and forgetfulness (12.5%). Among those lost to follow-up, 76.9% felt follow-up was not necessary and 23.1% cited insurance barriers. Regarding understanding, 10.6% disagreed and 22.7% somewhat agreed with “I understand my diagnosis of TIA.” For medication rationale, 21.1% somewhat agreed and none disagreed with “I understand the rationale for prescribed stroke prevention medications.”
Medication-compliant patients were likely to attend outpatient follow-up (OR 6.17; 95% CI: 1.56–24.42; p<0.005), while other demographic data and cardiovascular risk factors were not significantly associated with compliance.
Conclusions:
About one in five TIA patients were non-adherent to secondary prevention medication or lost to follow-up, most often because patients decided it was not needed. Nearly one-third reported limited understanding of their diagnosis, highlighting the need for improved methods for patient counseling. Study limited by a small sample size.
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