• Hidayah Karuniawati Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Indonesia.
  • Zullies Ikawati Department of Faculty of Pharmacy, Gadjah Mada University, Indonesia
  • Abdul Gofir Department of Neurology, Faculty of Medicine, Gadjah Mada University, Indonesia.


Objective: Patients who survive from the first stroke have risk factors to be recurrent. Based on American Heart Association/American Stroke Association and PERDOSSI (Indonesian Neurologist Association), medications which are prescribed to reduce the risk of recurrent stroke as secondary stroke prevention therapies include antiplatelet/anticoagulant as well as antihypertensive and lipid lowering agent. Patients’ adherence to the secondary stroke prevention therapies is important to reduce the recurrent stroke.

 Methods: This is a quantitative research and the data was collected retrospectively. The number of subjects of this study were 165 respondents. The participants were interviewed by researchers about their adherence to secondary stroke prevention by Modified Morisky Adherence Scale 8 (MMAS-8) questionnaire. Patients’ adherence was stated as low (MMAS-8 score < 6); moderate (MMAS-8 score = 6-7) and high (MMAS-8 = 8). This research was taken at a teaching hospital in Central Java Indonesia.

Results: Of 165 participants, 48 participants (29%) were categorized to have low adherence, 43 participants (26%) had moderate adherence, and 74 participants (45%) had high adherence to secondary stroke prevention therapies. The reasons for not adhering to the medications were felt better (34.1%), forgetfulness (18.7%), boredom (16.5%), lack of family support (8.8%), lack of time (6.6%), felt worse (5.5%), concern about side effects (3.3%), preference to Complementary Alternative Medicines (3.3%), and cost (3.3%).

Conclusion: The number of patients who has high adherence to secondary stroke prevention was 45% and the most common reason why participants did not adhere to therapy was because they felt better (34.1%).  



1. Goldstein LB, Bushnell CD, Adam RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2011;42 Suppl 2:517-84.
2. Kemenkes RI. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. Badan Litbangkes Kementerian Kesehatatan RI Dan Data Penduduk Sasaran Pusdatin Kementerian Kesehatan RI; 2013.
3. Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, et al. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998;29:2491-500.
4. Jannah R. Analisis Faktor-Faktor Yang Berhubungan Dengan Resiko Terjadinya Stroke Iskemik Berulang di Unit Neuroscience Center Mayapada Hospital; 2014.
5. Adie K. Clinical Guideline for Secondary Prevention Management in Stroke. Edinburgh: Royal Cornwall Hospitals (NHS), 2012.
6. Dipiro J, Talbert R, Yee GC, Matzke GR, Wells BG, Posey M. Pharmacotherapy A: Pathophysiologic Approach. 8th ed. New York: McGraw-Hill Companies; 2011.
7. Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42 Suppl 1:227-76.
8. Lambert M. AHA/ASA guideline on prevention of recurrent stroke. Am Fam Physician 2011;83(8):993-1001.
9. Prabhakaran S, Chong JY. Risk factor management for stroke prevention. Continuum (Minneap Minn) 2014;20(2):296-308.
10. Bushnell C, Arnan M, Han S. A new model for secondary prevention of stroke: Transition coaching for stroke. Front Neurol 2014;5:219.
11. Karuniawati H, Ikawati Z, Gofir A. Pengaruh Pencegahan Sekunder Terhadap Kejadian Stroke Berulang Pada Pasien Stroke Iskemik Di RSUD. Dr. Moewardi Di Surakarta; 2015. Available from: id=80783&mod=penelitian_detail&sub=PenelitianDetail&typ=html. [Last accessed on 2016 Apr13].
12. Heidenreich PA. Patients adherence: The next frontier in quality improvement. Am J Med 2004;117 Suppl 2:130-2.
13. Bangalore S, Schwamm L, Smith EE, Singh IM, Liang L, Fonarow GC, et al. Secondary prevention after ischemic stroke or transient ischemic attack. Am J Med 2014;127 Suppl 8:728-38.
14. Oyekan E, Nirmalasuriya A, Martin J, Scott R, Dudl RJ, Gree K. The B-SMART appropriate medication-use process: A guide for clinicians to help patients - Part 2: Adherence, relationships, and triage. Perm J 2009;13 Suppl 4:62-9.
15. Gomes F, Emery PW, Weekes CE. Abstract T P142: Mortality and stroke recurrence in obese stroke patients: The obesity paradox in a London-based population. Stroke 2014;45 Suppl 1:ATP142.
16. Park TH, Ko Y, Lee SJ, Lee KS, Lee J, Han MK, et al. Identifying target risk factors using population attributable risks of ischemic stroke by age and sex. J Stroke 2015;17 Suppl 3:302-11.
17. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases WJCC 2015;3 Suppl 5:418-29.
18. Gehi AK, Ali S, Na B, Whooley MA. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease. Arch Intern Med 2007;167 Suppl 16:1798-803.
19. Bosworth HB. Medication Adherence: Making the Case for Increased Awareness. ???: Duke University Medical Center and National Consumers League; ???.
20. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence. Circulation 2009;119 Suppl 23:3028-35.
21. Hugtenburg JG, Timmers L, Elders PJ, Vervloet V, van Dijk L. Definitions, variants, and causes of nonadherence with medication: A challenge for tailored interventions. Patient Prefer Adherence 2013;7:675-82.
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How to Cite
Karuniawati, H., Z. Ikawati, and A. Gofir. “ADHERENCE TO SECONDARY STROKE PREVENTION THERAPIES IN ISCHEMIC STROKE PATIENTS AT TEACHING HOSPITAL IN CENTRAL JAVA INDONESIA”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 10, no. 14, May 2017, pp. 28-30, doi:10.22159/ajpcr.2017.v10s2.19478.
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