Women less likely to receive guideline-directed medical therapy after ischemic stroke
Statin, antihypertensive, and anticoagulant prescriptions within 30 days of discharge were less common in women than in men, and women were less likely to be adherent to statins and antihypertensive treatments at one year.
Women with ischemic stroke were less likely to be started on guideline-directed medical therapy (GDMT) and more likely to be nonadherent to statins and antihypertensive treatments in a real-world analysis of commercially insured patients.
To examine sex differences in prescription and adherence to GDMT, researchers used a commercial claims database to identify patients admitted to a hospital in the U.S. with ischemic stroke from 2016 to 2020. Initiation of GDMT was defined as any statin, antihypertensive, and anticoagulant prescription within 30 days of discharge (low-dose aspirin was not included since it is usually obtained over the counter). Medication adherence was estimated using the proportion of days covered (PDC) at one year, with a PDC less than 0.80 used to define nonadherence. Results were published Oct. 1 by Stroke.
The study included 15,919 patients who were hospitalized with ischemic stroke and newly started on GDMT. The mean age was 55.7 years, and 7,701 (48.3%) were women. Women were slightly younger than men (55.2 vs. 56.3 years) and had fewer comorbid conditions. Within 30 days of discharge, 10,302 patients (64.7%) were prescribed a statin and 5,501 (34.6%) were prescribed an antihypertensive agent.
Women were less likely than men to be prescribed statins (58.0% vs. 71.8%), high-potency statins (39.7% vs. 53.6%), oral anticoagulants (41.2% vs. 45.0%) including direct oral anticoagulants (34.7% vs. 38.0%), and any antihypertensive agent (27.7% vs. 41.8%), including in the subgroup of patients with hypertension (45.7% vs. 58.4%).
Among 1,568 patients with atrial fibrillation/flutter, 679 (43.3%) were prescribed an oral anticoagulant, with lower rates in women than in men (41.2% vs. 45.0%). At one year, women were more likely than men to be nonadherent to statins (47.3% vs. 41.6%; P<0.0001), antihypertensives (33.3% vs. 32.2%; P=0.005), and both medications (49.6% vs. 45.0%; P=0.003) and were more likely to be nonadherent to GDMT in multivariable analysis (odds ratio, 1.23; 95% CI, 1.08 to 1.41).
The authors concluded that in this real-world observational analysis of commercially insured patients with acute ischemic stroke, women were less likely to be started on GDMT within 30 days after discharge and were less likely to be adherent to statins and antihypertensive agents at one year. They called for future efforts to understand the causes of the observed sex differences in GDMT.
“The unique barriers facing women with regard to receiving evidence-based, guideline-recommended care should be characterized,” the authors wrote. “Such information is critically important for the development of novel interventions designed to address and minimize these disparities.”