Volume : 13, Issue : 06, June – 2026

Title:

OPTIMIZING POST-STROKE OUTCOMES: A COMPREHENSIVE REVIEW OF MEDICATION ADHERENCE, QUALITY OF LIFE AND INNOVATIVE INTERVENTIONS IN SECONDARY PREVENTION

Authors :

Asika Dileep, Betty George, Honey Mariya Babu, Jismi Jackson, Kadeejathul Hana K P, Dr. Aswathy K.A, Dr. T. Tamilselvan

Abstract :

Globally, stroke continues to be a leading cause of mortality and long-term impairment. A major barrier to preventing subsequent strokes is poor medication adherence, which raises the risk of recurrence and has a detrimental impact on health-related quality of life (HRQoL). This study examines factors impacting adherence and the efficacy of novel interventions by synthesizing evidence from 30 important studies published up until 2026, including cohort studies, cross-sectional analysis, qualitative research, and randomized controlled trials. After a stroke, persistent cognitive impairment can affect executive functioning and memory, making it challenging for patients to follow complicated drug schedules. inadequate patient activation, polypharmacy, physical infirmity, communication issues including aphasia, and inadequate health literacy are further barriers. Different age groups have different adherence patterns. While younger survivors frequently struggle with long-term treatment persistence due to psychological variables and decreased perception of risk, elderly persons face issues linked to frailty and pharmaceutical burden. Socioeconomic inequities, financial restraints, and restricted healthcare access all contribute to nonadherence, especially in rural and resource-constrained areas.
Poor oral anticoagulant adherence dramatically raises the likelihood of unfavourable outcomes and death in patients with atrial fibrillation. There is a reciprocal association between medication adherence and HRQoL, with non-adherence worsening functional results and poor quality of life decreasing treatment compliance. HRQoL is also influenced by geographic location, availability to rehabilitation, and a smooth transition back into regular life.
Mobile health reminders, pharmacist-led pictogram labeling, multimedia instructional tools, and customized visual aids are examples of modern therapies that prioritize patient-centered strategies. These techniques increase medication adherence, boost self-efficacy, lower the risk of stroke recurrence, and improve stroke survivors’ long-term quality of life when paired with multidisciplinary care and ongoing lifestyle counselling.
Keywords: Stroke recurrence, Medication adherence, Secondary prevention, Health Related Quality of life (HRQoL), Stroke survivors, Transient ischemic attack (TIA), Cognitive impairment, Patient education

Cite This Article:

Please cite this article in press Asika Dileep et al., Optimizing Post-Stroke Outcomes: A Comprehensive Review Of Medication Adherence, Quality Of Life And Innovative Interventions In Secondary Prevention, Indo Am. J. P. Sci, 2026; 13(06).

REFERENCES:

1. Mahavadia M, Agrawal A. Medication adherence among post-stroke elderly patients: a cross-sectional study. Cureus. 2025;17(4).
2. Jamison J, Graffy J, Mullis R, Mant J, Sutton S. Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care. Br J Gen Pract. 2016;66(649).
3. Rohde D, Gaynor E, Large M, Mellon L, Bennett K, Williams DJ, et al. Cognitive impairment and medication adherence post-stroke: a five-year follow-up of the ASPIRE-S cohort. PLoS One. 2019;14(10).
4. Kamal AK, Shaikh Q, Pasha O, Azam I, Islam M, Memon AA, et al. A randomized controlled behavioural intervention trial to improve medication adherence in adult stroke patients with prescription tailored short messaging service (SMS): SMS4Stroke study. BMC Neurol. 2015;15:212.
5. Jamison J, Sutton S, Mant J, De Simoni A. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors’ and caregivers’ views from an online stroke forum. BMJ Open. 2017;7(7).
6. Wang Q, Tang M, Gao H, Sha Y, Yao M, Zhu Y, et al. Long-term secondary preventive medication persistence and adherence in young ischemic stroke survivors: a prospective single-center cohort study. Brain Behav. 2026;16(2).
7. Smith S, Parkinson J, Caitens T, Sanders A, Murphy L, Hamilton K. Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke. BMJ Open. 2023;13(1).
8. Kronish IM, Diefenbach MA, Edmondson DE, Phillips LA, Fei K, Horowitz CR. Key barriers to medication adherence in survivors of strokes and transient ischemic attacks. J Gen Intern Med. 2013;28(5):675-682.
9. Khettar S, Jacquin Courtois S, Luaute J, Decullier E, Bin S, Dupuis M, et al. Multiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study). Eur J Hosp Pharm. 2022;29(3):169-175.
10. Crayton E, Wright AJ, Ashworth M. Improving medication adherence in stroke survivors: the intervention development process. BMC Health Serv Res. 2018;18(1):772.
11. Tiili P, Leventis I, Kinnunen J, Svedjebäck I, Lehto M, Karagkiozi E, et al. Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation. Ann Med. 2021;53(1):1613-1620.
12. Cheiloudaki E, Alexopoulos EC. Adherence to treatment in stroke patients. Int J Environ Res Public Health. 2019;16(2):196.
13. Liljehult J, Molsted S, Møller T, Overgaard D, Christensen T. Lifestyle counselling as secondary prevention in patients with minor stroke or transient ischemic attack: a randomized controlled pilot study. Pilot Feasibility Stud. 2024;10(1):50.
14. Njohjam MN, Falonne NT, Ngoule MO. Barriers to medication adherence for secondary stroke prevention in rural communities in Cameroon: a qualitative study. BMC Prim Care. 2025;26(1):125.
15. Verma SJ, Gulati P, Injety RJ, Arora D, Dhasan A, Singhania A, et al. Secondary prevention by structured semi-interactive stroke prevention package in India (SPRINT INDIA): findings from the process evaluation of a randomized controlled trial. Eur Stroke J. 2023;8(4):1053-1063.
16. Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence: a population-based cohort study. Stroke. 2020;51(8):2435-2444.
17. Merks P, Swieczkowski D, Balcerzak M, Religioni U, Drelich E, Krysiński J, et al. Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety. Cardiol J. 2021;28(6):879-886.
18. Ramos-Lima MJM, Brasileiro IC, Lima TL, Braga-Neto P. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics (Sao Paulo). 2018;73..
19. Chen Q, Cao C, Gong L, Zhang Y. Health-related quality of life in stroke patients and risk factors associated with patients for return to work. Medicine (Baltimore). 2019;98(16).
20. Rancic NK, Mandic MN, Kocic BN, Veljkovic DR, Kocic ID, Otasevic SA. Health-related quality of life in stroke survivors in relation to the type of inpatient rehabilitation in Serbia: a prospective cohort study. Medicina (Kaunas). 2020;56(12):666.
21. Mahesh PKB, Gunathunga MW, Jayasinghe S, Arnold SM, Liyanage SN. Post-stroke quality of life index: a quality of life tool for stroke survivors from Sri Lanka. Health Qual Life Outcomes. 2020;18(1):239.
22. Adigwe GA, Alloh F, Smith P, Tribe R, Regmi P. Assessment of health-related quality of life of stroke survivors in Southeast communities in Nigeria. Int J Environ Res Public Health. 2024;21(9):1116.
23. Sakr F, Dabbous M, Akel M, Salameh P, Hosseini H. Adherence to post-stroke pharmacotherapy: scale validation and correlates among a sample of stroke survivors. Medicina (Kaunas). 2022;58(8):1109.
24. Sui W, Wan LH. Association between patient activation and medication adherence in patients with stroke: a cross-sectional study. Front Neurol. 2021;12:722711.
25. Lumbantobing VBM, Priastomo M, Kosasih CE, Rhamelani P, Anggadiredja K, Adnyana IK. Analysis of factors affecting quality of life in middle-aged stroke patients (under 65 years old) in the rehabilitation phase: multivariate regression analysis. J Multidiscip Healthc. 2025;18:3477-3491.
26. Mei YX, Zhang ZX, Wu H, Hou J, Liu XT, Sang SX, et al. Health-related quality of life and its related factors in survivors of stroke in rural China: a large-scale cross-sectional study. Front Public Health. 2022;10:810185.
27. Bauer M, Johansson MB, Schalling E, Kjork E. Identification and applications of key elements in the development of pictorial support for people with aphasia after stroke: a co-design approach. Health Expect. 2025;28(6).
28. Chu YM, Choi KS. Effectiveness of patient education in acute stroke: a comparison between a customised computer system and a pictorial information booklet. BMJ Health Care Inform. 2020;27(3).
29. Hoarau D, Ramos I, Termoz A, Fernandez V, Rambure M, Allemann SS, et al. Determinants of adherence to post-stroke/transient ischemic attack secondary prevention medications: a cohort study. Eur J Neurol. 2024;31(10).
30. Appalasamy JR, Quek KF, Md Zain AZ, Joseph JP, Seeta Ramaiah S, Tha KK. An evaluation of the video narrative technique on the self-efficacy of medication understanding and use among post-stroke patients: a randomized controlled trial. Patient Prefer Adherence. 2020;14:1979-1990.