Medical prophylaxis following hospitalization for ischemic stroke: age- and sex-related differences and relation to mortality.
BACKGROUND
The extent and implications of age- and sex-related differences in prophylaxis following ischemic stroke are unknown. We examined differences in the use of medical prophylaxis across age and sex groups in stroke patients after hospital discharge in Denmark and estimated the possible impact on age- and sex-related differences in mortality.


METHODS
A nationwide population-based follow-up study was conducted involving 28,634 patients hospitalized for ischemic stroke in 2003-2006 who survived 30 days after discharge. The proportion of patients who filled prescriptions for cardiovascular drugs within 0-6 and 12-18 months after discharge was determined. Mortality rates were compared across age and sex groups with and without controlling for use of medical prophylaxis.


RESULTS
Increasing age was associated with lower prophylaxis. Adjusted odds ratios for the use of a combination of a platelet inhibitor, an antihypertensive and a statin were 0.45 [95% confidence interval (CI): 0.38-0.54] and 0.52 (95% CI: 0.43-0.62) for men and women >80 years, respectively, compared with men ≤65 years. No systematic sex-related differences were identified. Continued drug use ranged from 66.1 to 91.9% for different drugs 12-18 months after discharge, with the lowest rate of continued use found among patients >80 years. Controlling for use of medical prophylaxis was associated with lower mortality rate ratios for elderly compared with younger patients.


CONCLUSIONS
Continuous efforts are warranted to ensure implementation of evidence-based secondary prophylaxis among elderly patients with ischemic stroke.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. kdp @ dce.au.dk
Kaare Haurvig
KH
Palnum
Frank
F
Mehnert
Grethe
G
Andersen
Annette
A
Ingeman
Birgitte Randrup
BR
Krog
Paul Daniel
PD
Bartels
Søren Paaske
SP
Johnsen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003718:Denmark; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data*; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents