Secondary stroke prevention among stroke survivors in Riyadh city, Saudi Arabia. Risk Knowledge, adherence to stroke discharge medications and preventive strategies

To assess knowledge about secondary stroke and adherence to stroke discharge medication and prevention strategies among stroke survivors, and to identify possible causes of poor adherence. A cross-sectional study that involved 82 stroke survivors who were treated at Prince Mohammed Bin Abdulaziz Hospital (PMAH) in Riyadh, Saudi Arabia, from July 2015 to August 2018. Patient adherence level (PAL) was assessed using a tool developed by Sidorkiewicz et al (2016). Of the 82 participants, 63.4% believed that the risk of secondary stroke is higher and 70.7% believed it would results in worse outcome, compared to primary stroke. Out of a list of 7 preventive strategies, treating risk factors (80.5%), keeping a healthy diet (65.9%) and regular exercise (63.4%) were the most frequently identified. Forgetful-ness (51.2%), polypharmacy (18.3%) and patient-perceived improvement (17.1%) were the most frequently reported causes for nonadherence. At the patients` level, PAL was adequate among 46.8%, and was higher among females (60.0% versus 35.7%, p=0.033) and married (52.2% versus 0.0%, p=0.006) ones, and lower among smokers (22.2% versus 54.2%, p=0.029), compared to their counterparts. No correlation of adherence level with knowledge was observed. Regression showed approximation to statistical significance for smoking (OR=4.28 [0.99, 18.41], p=0.051) as a predictor for inadequate adherence. Stroke survivors have suboptimal adherence to discharge prescriptions and preventive strategies, despite a relatively sound knowledge, which exposes them to high risk of secondary stroke. It is part of the healthcare providers` role to identify eventual barriers to adherence and to implement efficacious strategies to alleviate such barriers and improve patients` adherence.