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NEUROLOGY 2006;66:313-318
© 2006 American Academy of Neurology

Secondary-prevention drug prescription in the very elderly after ischemic stroke or TIA

Bruce Ovbiagele, MD, Nancy K. Hills, PhD, MBA, Jeffrey L. Saver, MD, S. Claiborne Johnston, MD, PhD for the CASPR Investigators*

From the Stroke Center and Department of Neurology (B.O., J.L.S.), UCLA Medical Center, and Stroke Sciences Group (N.K.H., S.C.J.), Department of Neurology, University of California, San Francisco.

Address correspondence and reprint requests to Dr. B. Ovbiagele, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095; e-mail: Ovibes{at}mednet.ucla.edu

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 ≥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 ≥80 and 534 age <80 admitted with stroke or TIA during the study period. Patients ≥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 ≥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.

Conclusion: After hospitalization for stroke or TIA, no differences in overall optimal treatment prescription of secondary-prevention medications between patients ages ≥80 and their younger counterparts were observed.

*See the Appendix for a complete list of Group members.

Supported by the Centers for Disease Control (U50 CCU920271).

Disclosure: Dr. Ovbiagele has received grant support and speaker honoraria from Sanofi-Aventis and Boehringer-Ingelheim Pharamaceuticals. The authors report no conflicts of interest.

Received August 3, 2005. Accepted in final form October 24, 2005.


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