Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke.
BACKGROUND
Prior studies have suggested lower use of guideline-recommended therapy and worse poststroke outcomes in older patients. We sought to examine age-related differences in characteristics, performance measures, temporal trends, and early clinical outcomes for acute ischemic stroke in a large contemporary cohort.


RESULTS
The relationships between age and clinical characteristics, performance measures, and in-hospital outcomes were analyzed in 502 036 ischemic stroke admissions from 1256 hospitals in the Get With the Guidelines-Stroke program from 2003 to 2009. Data were analyzed by age groups (<50, 50 to 59, 60 to 69, 70 to 79, 80 to 89, and >/=90 years) and with age as a continuous variable. Seven predefined performance measures and 2 summary measures were analyzed. Mean age of ischemic stroke patients was 71.0+/-14.6 years; 52.5% were women. Older patients were more likely to have a history of atrial fibrillation or hypertension and less likely to be black, Hispanic, or current/recent smokers. Although modest age-related differences in each individual performance measure were identified, there were substantial temporal improvements in performance measures from 2003 to 2009 in each age group, and many age-related treatment gaps were narrowed or eliminated over time. Older patients were less likely to be discharged home (adjusted odds ratio, 0.69; 95% confidence interval, 0.68 to 0.69) and more likely to die in hospital (adjusted odds ratio, 1.27; 95% confidence interval, 1.25 to 1.29) for each 10-year age increase.


CONCLUSIONS
Older patients with ischemic stroke differ in clinical characteristics and experience higher in-hospital mortality than younger patients. Performance measure-based treatment rates improved substantially over time for ischemic stroke patients in all age groups, resulting in smaller age-related treatment gaps.
Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
Gregg C
GC
Fonarow
Mathew J
MJ
Reeves
Xin
X
Zhao
DaiWai M
DM
Olson
Eric E
EE
Smith
Jeffrey L
JL
Saver
Lee H
LH
Schwamm
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008077:Lipoproteins, LDL / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator