Secondary-prevention drug prescription in the very elderly after ischemic stroke or TIA.
BACKGROUND
An age bias may exist in the prescription of important secondary-preventive therapies in the elderly.


OBJECTIVE
To evaluate patterns of drug prescription for cardiovascular prevention in the very elderly following hospitalization for an acute ischemic stroke or TIA.


METHODS
The authors compared subjects ages > or = 80 with those < 80 in the California Acute Stroke Prototype Registry to evaluate the impact of age on receipt of secondary-prevention medications at the time of hospital discharge. Prespecified secondary-prevention drug classes studied were antithrombotics, lipid-lowering agents, and antihypertensives.


RESULTS
Overall, there were 260 patients age > or = 80 and 534 age < 80 admitted with stroke or TIA during the study period. Patients > or = 80 years were less likely to receive actual treatment with antithrombotic medications (p = 0.002) and lipid-lowering medications (p = 0.005) but were more likely to receive antihypertensive medications (p = 0.0007) than their younger counterparts. With regard to optimal treatment (defined as receipt of, or a valid contraindication to, treatment in each category), those > or = 80 were equally likely to receive antithrombotic medications and lipid therapy but remained more likely to receive antihypertensive treatment (77.7 vs 67.0%; p = 0.0007). There were no differences in receipt of optimal combination therapy (defined as optimal treatment in all three therapeutic classes) between patient age groups, even when adjusted for medical history.


CONCLUSIONS
After hospitalization for stroke or TIA, no differences in overall optimal treatment prescription of secondary-prevention medications between patients ages > or = 80 and their younger counterparts were observed.
Ovbiagele
Bruce
B
Stroke Center, Department of Neurology, UCLA Medical Center, San Francisco, CA, USA. Ovibes@mednet.ucla.edu
Hills
Nancy K
NK
Saver
Jeffrey L
JL
Johnston
S Claiborne
SC
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000188:drug therapy*
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents