Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Age and Sex Disparities in the Primary Prevention of Stroke or TIA in Australian General Practice: Linked Registry and General Practice Data (#77)

Kiran Bam 1 , Muideen Olaiya 1 , Joosup Kim 1 2 , Dominique Cadilhac 1 2 , Chris Pearce 3 , Nadine Andrew 4 5 , Lauren Sanders 6 7 , Amanda Thrift 1 , Mark Nelson 8 , Seana Gall 8 , Monique Kilkenny 1 2
  1. Monash University, Clayton, VICTORIA, Australia
  2. Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
  3. Outcome Health, Blackburn, Victoria, Australia
  4. Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
  5. National Centre for Healthy Ageing, Frankston, Victoria, Australia
  6. St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  7. Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
  8. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

Background: Little is known about the primary prevention of stroke in Australian general practices.

Aims: To describe the primary prevention of stroke/TIA in Australian general practices, and investigate whether there are any demographic disparities.

Methods: Analysis of adults with acute stroke/TIA (2014-2018), using linked de-identified data from the Australian Stroke Clinical Registry and general practices from three Victorian Primary Health Networks. Patients were eligible if they had ≥2 encounters with general practice within 12 months immediately before the index stroke/TIA Primary stroke prevention was evaluated based on the provision of two guideline-recommended processes: 1) assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, body weight), and 2) prescription of prevention medications among those clinically indicated (antihypertensive, lipid-lowering, glucose-lowering, antithrombotic agents). Outcomes included attainment of risk factor targets. Multivariable regression models were used to determine associations of age and sex with receiving recommended care processes or attaining risk factor targets.

Results: A total of 3,041 patients from 348 general practices were included (23.8% aged ≥85 years; 47% women). Patients were assessed for a median two risk factors within 12 months immediately before stroke/TIA, mostly blood pressure (79.8%) and serum lipids (49.0%). The most commonly prescribed prevention medications were antihypertensive agents (63.1%) and lipid-lowering medications (40.7%). In multivariable models, there was a significant non-linear (U-shaped) association between age and care processes received or outcomes (p<0.001). Compared to patients aged 65-85 years, those aged <65 years or ≥85 years had fewer risk factors assessed, fewer classes of medications prescribed, and were less likely to attain risk factor targets. This non-linear association was more pronounced among women, with those aged ≥85 years having more sub-optimal outcomes.

Conclusion: Primary prevention of stroke in Australian general practices differs by age and sex. Older women with stroke may require more support to ensure equitable care.