Primary care management of stroke in people with dementia: Linked registry and general practice data

Objectives

To evaluate whether risk factor management in Australian general practices for secondary prevention of stroke differs by dementia status.

Methods

A retrospective study of adults with acute stroke or transient ischaemic attack (TIA) from 2014 to 2018, using de-identified linked data (2014–2020) from the Australian Stroke Clinical Registry and three Primary Health Networks in Victoria. Eligibility included being discharged home or to inpatient rehabilitation, and having two or more encounters with general practice during the chronic phase (7–18 months) postindex stroke/TIA. We evaluated the assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose and urinary protein), prescription of prevention medications and attainment of risk factor targets, within 7–18 months postindex stroke/TIA. Regression models were used to determine any differences in risk factor management.

Results

Among 3376 eligible survivors of stroke/TIA (median age 73.9 years, 22% TIA), 140 (4%) had evidence of a dementia diagnosis. In multivariable analyses, dementia was associated with fewer risk factors being assessed (incidence rate ratio [IRR] .86, 95% confidence interval [95% CI] CI .76–.98) or medication classes being prescribed (IRR .88, 95% CI .78–.98). No significant difference was observed in the attainment of risk factor targets.

Conclusions

Although patients with dementia were less often assessed for risk factors or prescribed medications for secondary prevention of stroke, the control of risk factors did not differ by dementia status. Current findings may reflect appropriate clinical decision-making for managing people with dementia approaching the end of life.