Long-term Care

Only about half of stroke survivors living in nursing homes receive medicine to prevent another stroke

Only half of residents of nursing homes in five States who had suffered a stroke during the 1990s received any medication to prevent another stroke. Furthermore, minority residents were less likely than white residents to receive the anticoagulant warfarin to prevent further strokes, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00011).

Jennifer B. Christian, Pharm.D., M.P.H., of Brown University, and her colleagues identified 19,051 nursing home residents who had been hospitalized for ischemic stroke in five States from 1992 to 1996. They compared use of aspirin, dipyridamole, ticlopidine, and warfarin alone or in combination to prevent a second stroke for each racial/ethnic group.

Overall, only half of elderly residents who had suffered a stroke within the past 6 months received medication to prevent a second stroke. Use of all four medications by members of ethnic/racial groups varied widely, with 58 percent of American Indians and 39 percent of Asian/Pacific Islanders receiving at least one of these medications. Most residents (68 to 77 percent) did not receive aspirin. Most residents (60 to 75 percent) who were eligible for anticoagulant therapy did not receive warfarin.

After controlling for confounding factors, Asian/Pacific Islander, black, and Hispanic nursing home residents eligible for anticoagulant therapy received warfarin less often than white residents. Use of warfarin requires frequent laboratory monitoring to assess efficacy and safety, which may discourage doctors from prescribing it. The low estimates of use of aspirin, an antiplatelet recommended for all patients who have experienced a noncardioembolic stroke or transient ischemic attack, is also a concern. Interventions designed to improve the pharmacological management of recurrent stroke regardless of race are needed in the nursing home setting, conclude the authors.

More details are in "Racial disparities in receipt of secondary stroke prevention agents among U.S. nursing home residents," by Dr. Christian, Kate L. Lapane, Ph.D., and Rebecca S. Toppa, Ph.D., in the November 2003 Stroke 34, pp. 2693-2697.

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