Recommended therapies after ischemic stroke less likely to be received by the elderly

Older patients, especially those who are very elderly, those admitted from skilled nursing facilities, and those with functional dependence, are less likely to receive recommended antithrombotic medications after an ischemic stroke, according to a new study.

Researchers analyzed data from 31,554 Medicare fee-for-service beneficiaries who were discharged after an ischemic stroke and were randomly chosen for the Medicare Health Quality Improvement Program's National Stroke Project in 1998-1999 and 2000-2001. The purpose of the study was to examine age-specific differences in receipt of deep venous thrombosis (DVT) prophylaxis and antithrombotics, as well as whether certain patient characteristics were associated with appropriate treatment or lack thereof. Patients were divided into age groups of 65 to 74 years, 75 to 84 years, and 85 years or older. The study was published online Nov. 23 by Circulation: Cardiovascular Quality and Outcomes.

The authors found that 14.9% of those eligible to receive in-hospital pharmacologic DVT prophylaxis actually received it. Rates were higher among those eligible for in-hospital treatment with antiplatelet drugs (83.9%) and anticoagulants for atrial fibrillation (82.8%), and for those eligible to be dismissed on an antithrombotic medication (74.2%). In general, treatment became less likely with increasing age, and patients older than 85 years were least likely to receive recommended treatment (11.4% received DVT prophylaxis, 78.3% received antiplatelet medications, 76.3% received anticoagulants for atrial fibrillation, and 70.3% received antithrombotics at discharge). Patients admitted from a skilled nursing facility and those with functional dependence were also less likely to receive these therapies.

The authors noted that their study may have underestimated the proportion of patients prescribed antithrombotics because of missing documentation, especially for aspirin, and that they had no data on physicians' decision-making regarding prescription of these therapies. However, they concluded that antithrombotic therapies were likely to be underused in elderly patients, particularly in those of increasing age, those transferred from a skilled nursing facility, and those with functional dependence. They called for further studies to determine the reasons behind the apparent discrepancies between recommended and actual treatment in these groups, since their data suggest an opportunity to improve care.