| pA2 online © Copyright 2004 The British Pharmacological Society |
147P
University of Newcastle Winter Meeting December 2004 |
Evidence for gender differences in the management of stroke in scotland C. R. Simpson1, C. Wilson2, P. C. Hannaford1 & D. Williams2. 1Department of General Practice & Primary Care, The University of Aberdeen and 2Department of Clinical Pharmacology, Grampian Universities Trust. |
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Print abstractStroke is the third largest cause of death in Scotland [1]. Aspirin, [2] statins, [3] the use angiotensin-converting enzyme (ACE)-inhibitors and thiazides, [4] blood pressure reduction [5] and anticoagulation therapy for patients with atrial fibrillation [6] have a proven role in the secondary prevention of stroke. The aim was to investigate whether gender differences existed in the secondary prevention of stroke in Scottish general practice.
Anonymized, routinely collected data was obtained by the Primary Care Clinical Informatics-Research Unit on 377 439 patients registered with 62 family practices participating in the continuous morbidity recording system. The key characteristics of gender, age, smoking, hypercholesterolaemia, number of related co-morbidities and deprivation for stroke patients, as at March 2004, were determined. Use of secondary prevention treatments from April 1st 2003 to March 31st 2004 was determined usingbinary logistic regression. Odds ratios were adjusted for potential confounding.
2.7% (10 076) of all patients registered in our study practices had a code for stroke with 9201 (2.4%) having ischaemic stroke on their records. Overall, 19.5% of stroke patients received a thiazide and 29.2% an ACE-inhibitor in the year ending March 31st 2004. 74.8% of ischaemic stroke patients received either an antiplatelet or warfarin and 42.8% a statin. Of the stroke patients with hypertension 79.4% had their blood pressure measured in the last year. 54.9% of ischaemic stroke patients with an additional label of atrial fibrillation were prescribed an antiplatelet, 52.3% were prescribed warfarin and 92.1% received either. Women with a label stroke were significantly less likely to receive an ACE-inhibitor (odds ratio (OR) 0.7, 95% confidence intervals (CI) 0.7, 0.8) but more likely to receive a thiazide (OR 1.5 CI 1.4, 1.7). Women with ischaemic stroke were significantly less likely to receive either an antiplatelet or warfarin (OR 0.8, CI 0.8, 0.9) or a statin (OR 0.9 CI 0.8, 0.9). Women with stroke and an additional doctor label of hypertension were more likely to have higher blood pressure (systolic > 140 mmHg, diastolic > 90 mmHg) than men but this was not statistically significant . Gender differences also occurred for women with ischaemic stroke who had an additional doctor label of atrial fibrillation, being more likely than men to be prescribed an antiplatelet (OR 1.3 CI 1.0, 1.7) and less likely to be prescribed warfarin (OR 0.6, CI 0.5, 0.8).
This analysis of prescribing data derived from a number of practices in Scotland has revealed important differences in the provision of secondary preventive treatments and other therapies for ischaemic stroke and for those with additional labels of hypertension and atrial fibrillation. Our results suggest women need to be targeted for secondary prevention therapy in order to benefit from the coronary heart disease and stroke strategy for Scotland.
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