Utilization of medications for secondary prevention in stroke patients at hospital discharge — The Association Specialists
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Utilization of medications for secondary prevention in stroke patients at hospital discharge (303)

Beata Bajorek 1 , Ashraf Eissa 2 , Ines Krass 2
  1. UTS & Royal North Shore Hospital, Broadway, NSW, Australia
  2. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia

Background: Significant proportions (33%) of stroke presentations are by patients with a previous stroke. Consequently, stroke management guidelines recommend that all ischaemic stroke patients receive 3-key evidence-based preventive pharmacotherapy: antihypertensive agents, a statin, and antithrombotic therapy (anticoagulant and/or antiplatelet).

Aims: To determine the rates of utilization of the 3-key evidence-based drug therapies for the secondary prevention of stroke and to identify factors associated with use of treatment at discharge.

Methods: A retrospective clinical audit was conducted in five metropolitan hospitals in NSW, comprising two tertiary referral centres and three district hospitals. Patients discharged with a principal diagnosis of ischaemic stroke during a 12-month time period were identified for review.

Results: A total of 521 medical records were reviewed. Of these, 469 patients were discharged alive with a mean age of 73.6 ± 14.4 years. Overall, 75.4% were prescribed an antihypertensive agent at discharge versus only 65.7% on admission (P<0.05). Three hundred-sixty patients (77.6% of the treatment-eligible patients) were prescribed a statin at discharge (compared to only 43.9% on admission, P<0.05). Almost all (97.6%) eligible patients were prescribed an antithrombotic at discharge, of whom 68.5% were prescribed monotherapy and 28.2% were prescribed dual therapy. Only 60.0% of eligible patients were discharged on all 3-key guideline recommended secondary preventive drug therapies. Multivariate logistic regression analyses showed that hypertension (OR=6.67; 95%CI: 4.35-11.11), hypercholesterolemia (OR=2.04; 95%CI: 1.32-3.23), and discharge destination (OR=0.22; 95%CI: 0.10-0.48) were associated with the utilization of all 3 guideline recommended therapies.

Conclusion: There is a scope for improvement in implementing the stroke management guidelines when it comes to prescribing secondary preventive drug therapies using antihypertensives, antithrombotics and statins. Appropriate risk/benefit assessment is indispensable for optimal prescribing and maximizing patient outcomes, particularly in older people.