Temporal Trends in the Use of Primary Prevention Medications at Stroke Admission

Over 80% of strokes are preventable through appropriate management of cardiovascular risk factors including pharmacotherapy interventions (antihypertensive and lipid-lowering medications). We aimed to: i) determine the proportion of patients reported to use primary prevention medications before their first stroke admission; and ii) compare differences in the use of these medications over time, by sex and age.

Secondary analysis of cross-sectional clinical data from the Stroke Foundation biennial National Stroke Audit - Acute Services (2007-2019; 7 cycles). Data collected for adult patients with first-ever stroke included demographics (age, sex), stroke presentation information (stroke type) and medical history (risk factors, use of primary prevention medications, pre-stroke independence [modified Rankin Scale]). Patient data were summarized with descriptive statistics. Adjusted proportions (year, age, sex, pre-stroke independence) of medication use were derived from multivariable logistic regression models. Proportions were compared across audit years using Cochrane Armitage tests for linear trends (Ptrend), and analyzed by pre-specified sub-groups (men vs women; aged <65 vs ≥65 years).

Of 17,944 patients (median age 74.6 years; 54.5% male), most had a history of hypertension (73.0%), and 48.4% had hypercholesterolemia before stroke. Significant increases in the use of antihypertensive medications were observed over time, particularly for women (all ages Ptrend=0.004, 0.2% increase per cycle), especially women aged <65 years (Ptrend=0.006, 1.1% increase per cycle). There was an increase in the use of lipid-lowering medications for men (Ptrend<0.001, 0.7% increase per cycle) and all patients aged <65 years (Ptrend<0.001, 1.5% increase per cycle). Only men aged ≥65 years had an increase in the use of lipid-lowering medication over time (Ptrend=0.037, 0.4% increase per cycle).

The use of primary prevention medications before first stroke increased over time in the audited stroke episodes from participating Australian hospitals. There were disparities across sex and age groups, indicating opportunities to improve equitable access to guideline recommended care to enhance primary stroke prevention.