The effect of adherence to prior therapy on stroke severity and outcomes
DOI: 10.32364/2587-6821-2026-10-10-1
The effect of adherence to prior therapy on stroke severity and outcomes
B.A. Abusueva, A.A. Ramazanov
Dagestan State Medical University, Makhachkala, Russian Federation
Background: stroke remains one of the leading causes of mortality and disability. Adherence to prior therapy represents a modifiable factor that significantly affects the disease severity and clinical outcomes. This relationship has to be investigated to optimize primary prevention strategies, to substantiate methods for assessing compliance in retrospective studies, and to improve prognosis in patients with cerebrovascular risk factors.
Aim: to establish a relationship between patient adherence to prior therapy (assessed by indirect criteria), severity of neurological deficit, thrombolytic therapy frequency, and functional outcomes of stroke.
Materials and Methods: a retrospective cohort analysis was conducted on data from 60 patients with acute stroke admitted from December 2025 to February 2026. Adherence was assessed by three indirect criteria (drug intake regularity: ≥80%, frequency of scheduled visits: ≥1 time per 6 months, structured self-report) with correlation to the Morisky Medication Adherence Scale-8 (MMAS-8). Severity of neurological deficit and functional outcomes were evaluated by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at admission and discharge. Patients were stratified into compliant (n=28) and non-compliant (n=32) groups.
Results: in the Group 1, the first stroke episode occurred significantly later (70.0±8.2 years vs 64.6±9.4 years; p<0.05). According to the NIHSS, these subjects showed less severe neurological deficit at admission (9.2±3.8 vs 13.8±4.5 scores; p<0.01). At discharge, the proportion of patients with good functional outcomes (mRS: 0–1 scores) was 67.9% vs 21.9% (p<0.01) in the Groups 1 and 2, respectively. The Group 1 showed shorter mean hospital length of stay than the Group 2 (11.2±3.4 vs 13.8±4.7 days, respectively; p<0.05). Thrombolytic therapy (TLT) was performed in 10 (16.7%) patients; in the Group 1, it was used significantly more often (25.0% vs 9.4%; p<0.05). TLT patients demonstrated significantly lower NIHSS scores at discharge and upon completion of the acute period. This correlated with a higher proportion of good functional outcomes. Validation of indirect criteria demonstrated high concordance with the MMAS-8: 100% of compliant patients had ≥6 scores vs 84.4% of non-compliant patients with <6 scores (p<0,001).
Conclusions: adherence to prior therapy is associated with later stroke onset, less severe neurological deficit at admission, increased likelihood of reperfusion therapy, and better functional recovery at discharge. The three-component model of indirect compliance assessment demonstrates high discriminative ability and it may be recommended as a valid instrument for a retrospective clinical research. Better treatment adherence represents a significant reserve for improvement of stroke outcomes at both prehospital and inpatient stages.
Keywords: stroke, therapy adherence, compliance, retrospective study, thrombolytic therapy, prevention, arterial hypertension.
For citation: Abusueva B.A., Ramazanov A.A. The effect of adherence to prior therapy on stroke severity and outcomes. Russian Medical Inquiry. 2026;10(10):769–776 (in Russ.). DOI: 10.32364/2587-6821-2026-10-10-1
About the authors:
Burliyat A. Abusueva — C. Sc. (Med.), Assistant Professor, Head of the Department of Nervous Diseases, Medical Genetics and Neurosurgery, Dagestan State Medical University; 1, Lenin sq., Makhachkala, 367000, Russian Federation; ORCID iD 0000-0001-8493-9768
Arsen A. Ramazanov — 5th-Year Student, Dagestan State Medical University; 1, Lenin sq., Makhachkala, 367000, Russian Federation; ORCID iD 0009-0004-0033-2184
Contact information: Burliyat A. Abusueva, e-mail: burliyatabusueva@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 21.07.2026.
Revised 11.08.2026.
Accepted 02.09.2026.
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