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

Disparities in General Practice Management of Stroke by Dementia Status: Linked Registry and General Practice Study (#109)

Muideen Olaiya 1 , Joosup Kim 1 2 , Chris Pearce 3 , Dominique Cadilhac 1 2 , 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: Clinical management of survivors of stroke with dementia is challenging considering considerable impairments often experienced.

Aims: To evaluate whether stroke management in Australian general practices differs for patients with dementia.

Methods: A retrospective observational study of adults with acute stroke/TIA (2014-2018). Participants were identified through the Australian Stroke Clinical Registry, and linked with de-identified general practice data from three Victorian Primary Health Networks (2013-2020). Patients were eligible if discharged home or to rehabilitation, and had ≥2 encounters with general practice within 7-18 months post-index stroke/TIA (chronic stroke phase). Dementia status was determined based on historical recordings of dementia diagnosis or prescription of cholinesterase inhibitors, up to 6 months post-index event. Stroke/TIA management was evaluated within 7-18 post-index event, and included: assessment of cardiometabolic risk factors (blood pressure [BP], serum lipids, blood glucose, serum proteins, body weight); prescription of prevention medications (BP-, lipid-, glucose-lowering, antithrombotic agents); and attainment of targets for the cardiometabolic risk factors. Association between dementia and the quality of care and outcomes were determined using regression models.

Results: Of 3,528 eligible patients (median age 74 years, 44% females, 22% TIA), 147 (4%) had dementia. Adjusted for covariates (e.g. sociodemographic variables, other comorbidities), having dementia was significantly associated with not being assessed for BP (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.38-0.86), serum lipids (OR 0.52, 95% CI 0.36-0.78), or body weight (OR 0.61, 95% CI 0.38-0.97). Similarly, patients with dementia were less often prescribed BP-lowering agents (OR 0.67, 95% CI 0.45-0.99) or lipid-lowering medications (OR 0.61, 95% CI 0.42-0.89); or less often attained targets for blood glucose (OR 0.54, 95% CI 0.31-0.94).

Conclusion: General practices may need support with managing people with stroke and dementia. Findings should be interpreted in the context that information on any specialist care received is not captured in general practice data.