Secondary Stroke Prevention Trends in Low-Income Community-Dwelling Older Individuals

Background: Effective secondary stroke prevention is crucial in reducing recurrence and improving patient outcomes, particularly in low-income community-dwelling older individuals who face barriers to health care access. Proper management of modifiable risk factors, such as hypertension, hyperlipidemia, and atrial fibrillation (AF), is essential to prevent subsequent strokes in this vulnerable population. Objective This study describes medication use for secondary stroke prevention among low-income community-dwelling older individuals in Richmond, Virginia. Design: This study involved a retrospective chart review using data provided by the Mobile Health and Wellness Program (MHWP), formerly known as Richmond Health and Wellness Program. The data included patient-reported disease states and prescription medications, which was collected by faculty and students during medication reviews in the last two years. Setting The MHWP was established by the Virginia Commonwealth University in 2012 to provide free health care coordination services for older individuals living in low-income communities, including five Section 8 housing buildings in the east end of Richmond, Virginia. Patients, Participants: The study included 499 participants who were patients in the MHWP system between 2021 and 2023. Most participants were 65 years of age and older, female, and Black or African descent with a reported income of less than $1,000 per month. Interventions: Data from the MHWP charting system (2021-2023) were analyzed using SPSS 29.0 to determine antiplatelet and anticoagulation use among participants with a history of stroke/transient ischemic attack (TIA) or AF/flutter. Results: Of 499 participants, 62 (12.4%) reported having a history of stroke/TIA, and 19 (3.8%) reported AF/flutter. Aspirin was the most prescribed antiplatelet (46.8% for stroke/TIA, 36.8% for AF/flutter). However, 33.8% of stroke/TIA survivors and 21% of participants with AF/flutter were not taking any antiplatelet or anticoagulant. Stroke/TIA survivors had higher rates of hypertension (P = .011), atherosclerotic cardiovascular disease (P = .005), and epilepsy (P = .006) versus those without prior stroke/TIA. Discussion: Understanding the unique socioeconomic and health care challenges of this population in the context of secondary stroke prevention is crucial for developing effective interventions tailored to this population. In comparing disease states reported by patients with a history of stroke/TIA with other MHWP participants, hypertension emerges as the most prevalent condition. Hypertension stands out as an important modifiable risk factor for ischemic stroke due to its role in atherosclerosis development.⁹ Conclusion: More than one-third of stroke/ TIA survivors were not receiving antiplatelet or anticoagulation therapy, and almost 40% of stroke/ TIA survivors were not receiving statin therapy, emphasizing opportunities to optimize stroke risk reduction in this population.