There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .
Non–adherence to aspirin or oral anticoagulants in secondary prevention after ischaemic stroke
Abstract Background The effectiveness of medication is influenced by treatment adherence . After TIA or minor disabling stroke patients usually are advised to take antithrombotic medication .  Stroke patients are an interesting group of patients with respect to adherence , since cardiovascular risk factors and stroke may ( indirectly ) negatively influence brain function , which can affect adherence . We investigated determinants of non – adherence in patients who used aspirin or oral anticoagulation after cerebral ischaemia of arterial origin . Methods Data of patients prospect ively followed in two clinical trials ( the Dutch TIA Trial and the Stroke Prevention In Reversible Ischaemia Trial ) were analysed with Cox proportional hazards modelling . Results In the two trials 3796 patients were treated with aspirin .  During a mean follow – up of 2.1 years , 689 patients ( 18 % ) prematurely stopped treatment , 305 ( 8 % ) did so without a clear medical reason ( non – adherence ) . Age ≥ 65 years and the use of 300 instead of 30 mg of aspirin were independently associated with non – adherence . Diastolic blood pressure of ≥ 90 mmHg and dizziness were associated with better adherence . Of 651 patients on oral anticoagulation  , 143 patients ( 22 % ) stopped after a mean follow – up of 1.0 year , 66 ( 10 % ) did so because of nonadherence . No statistically significant determinants for non – adherence were identified . Conclusion As found in the literature on nonadherence in general , age of ≥ 65 years and a higher dose of aspirin ( 300 mg versus 30 mg ) were independently associated with non – adherence with aspirin treatment that was prescribed for secondary prevention after cerebral ischaemia of arterial origin . Older patients may require extra encouragement to continue antithrombotic treatment . Lower doses of aspirin may improve treatment adherence
There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .