Terapia farmacológica en la prevención secundaria del ictus isquémico en los muy ancianos: ¿ha mejorado en las últimas décadas?

Abstract

IntroductionPopulation aging has led to an increase in strokes in older patients (OP) aged ≥80 years. This work assesses how secondary prevention of ischemic stroke in OP has changed in recent decades. MethodThis work is a retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocío, and Virgen de Valme hospitals in Seville (Spain) during the periods of 1999-2001, 2014-2016, and 2019-2020. ResultOf the 1,806 patients studied, 349 (19.3%) were OPs. Over the 3time periods, the percentage of OPs doubled (13.5% vs. 25.9% vs. 28%; p=0.0001) and their age increased (83.3±3 vs. 84.1±3 vs. 85.2±4; p=0.001). Comparing the periods, OPs had more hypertension (69.9% vs. 84.8% vs. 84.6%; p=0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p=0.0001) and a greater percentage had prescriptions for antihypertensives (69.1% vs. 86.7% vs. 92.3%; p=0.0001), statins (5.3% vs. 78% vs. 81.5%; p=0.0001), and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p=0.001). OPs also received more antihypertensives (1±0.9 vs. 1.6±0.9 vs. 1.9±0.8 drugs; p=0.0001) and high-intensity statins (2.3% vs. 42.7% vs. 69.2%; p=0.0001). Comparing OPs to younger patients, there were no differences in antihypertensive treatment in any period, though there were differences in antithrombotic treatment in the first period. In regard to statins, the differences were maintained until the end. ConclusionsThe number of OPs has doubled in the last 20 years and they now represent over one-quarter of discharges. Although progress has been made in secondary stroke prevention in OP, there is room for improvement.