Schizophrenia, which is associated with increased risk for stroke, is also associated with poor adherence to secondary stroke prevention medications among older individuals, according to study findings published in Stroke.

Investigators examined rates of medication adherence for secondary stroke prevention among older individuals with and without schizophrenia who are ischemic stroke survivors.

The investigators conducted a population-based cohort study from April 2004 through March 2018 using administrative databases and ICD-10 codes to identify all patients aged older than 65 years and hospitalized in Ontario, Canada, with ischemic stroke. Those with schizophrenia were identified with a validated algorithm. Following discharge, patients with and without schizophrenia who filled a prescription for anticoagulant, lipid-lowering, or antihypertensive medications within 3 months and were alive after 1 year were compared for low adherence (defined as an annual proportion of days covered of <0.4). Universal coverage for physician and hospital services is given to all residents of Ontario, Canada. Patients with history of stroke (lookback to 1991), whose stroke occurred in-hospital, or were discharged to palliative care, psychiatric, or rehabilitation facilities were among those excluded.

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Future work should focus on the development and implementation of tailored interventions to optimize cardiovascular risk factor management in this population.

Overall, 55,842 patients were included in the analysis (mean age, 79.5 years; 53.3% women) and 1.0% had schizophrenia. Those with schizophrenia vs those without were younger (77 vs 80 years), more likely to be women (63.6% vs 53.2%), living in the lowest income neighborhoods (33.8% vs 22.7%), and less likely to fill prescriptions for secondary stroke prevention medications. Those without schizophrenia were more likely to have hypertension, dyslipidemia, or atrial fibrillation and less likely to have diabetes, and less likely to have 2 or more comorbidities.

Individuals with schizophrenia vs those without who filled prescriptions were more likely to have low adherence 1 year after discharge for anticoagulant medications (41.1% vs 32.0%; adjusted odds ratio [aOR], 1.61; 95% CI, 1.00-2.58), lipid-lowering medications (38.6% vs 29.8%; aOR, 1.60; 95% CI, 1.31-1.96), or antihypertensive medications (28.0% vs 18.8%; aOR, 1.60; 95% CI, 1.28-2.01) after adjustment in multivariable logistic regression for sex, age, comorbidities, residence, and socioeconomic status.

Study limitations include use of prescription claims data as proxy for medication adherence, no information on patient-level factors possibly affecting adherence (severity of psychiatric illness, drug allergies, contraindications), and medications provided to the study population were mostly free of charge (maximum $2) for all residents so results may not be generalizable to other pay-for-prescription systems.

 “…schizophrenia was associated with low adherence to medications for secondary stroke prevention, even in a high-risk population with recent contact with the health care system and minimal medication costs,” the investigators concluded. “Future work should focus on the development and implementation of tailored interventions to optimize cardiovascular risk factor management in this population.”

This article originally appeared on The Cardiology Advisor