Medication Adherence Trajectory and its Impact on Recurrent Stroke after Carotid Artery Stenting

Shou-hong Lin^1,2Mei-ling Yang^1,2Fei-fei Liu²Yi Zeng^1,2Ting-Ting Wu^1,2*

• ¹First Affiliated Hospital of Fujian Medical University, Fuzhou, China
• ²The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Background: Medication adherence is critical for patient outcomes, but remains insufficiently investigated in individuals following Carotid Artery Stenting (CAS). This study aims to investigate the trajectories and determinants of medication adherence and their impact on stroke recurrence in post-CAS patients. Methods: This study included patients who underwent CAS in the neurology department of a tertiary Grade A hospital in Fujian Province from January 2021 to May 2024. Medication adherence was assessed using the Medication Adherence Scale (MMAS-8) at 3, 6, and 12 months post-discharge, Stroke recurrence was evaluated at each follow-up visit. Group-Based Trajectory Modeling (GBTM) was utilized to analyze adherence trajectories, and logistic regression identified associated factors. Kaplan-Meier curves and Cox proportional hazards models were employed to assess the impact of adherence trajectories on stroke recurrence. Three Cox models were constructed: Model 1 (unadjusted), Model 2 (adjusted for age and sex), and Model 3 (further adjusted for significant variables from univariate analysis). Results: Medication adherence scores at 3, 6, and 12 months were 6.33±1.43, 5.06±1.31, and 4.81±1.47, respectively. Three distinct adherence trajectories were identified: high level decline (37.32%), medium level decline (31.58%), and persistently low level decline (31.10%). Multivariate regression analysis revealed that household income, family medication supervision, regular follow-up visits, and medication related-beliefs significantly influenced these trajectories (P<0.05). The 12-month stroke recurrence rate was 9.57%. Kaplan-Meier analysis demonstrated significant differences in stroke recurrence among the three trajectory groups (Log-rank and Breslow test, both P<0.001). In Models 1 and 2, high level decline was associated with significantly lower recurrence risk compared with persistently low level decline (P<0.05), but this association was not significant in Model 3 (P>0.05). Conclusion: Post-CAS patients demonstrate three distinct medication adherence trajectories, with socioeconomic, behavioral, and belief-related factors influencing long-term adherence. The high level decline group serves as a crucial protective factor in preventing stroke recurrence. underscoring the need for targeted interventions to maintain adherence and prevent recurrent stroke.